Patient Enrollment
Patients may enroll in any of our programs either directly through the Fund or through one of our participating pharmacies. Patients are enrolled on a first-come-first-served basis. We do, in certain circumstances, maintain a patient waiting list for assistance. Should this apply, we would contact each patient on the list in chronological order to determine if they still need assistance. Patient assistance is limited by the financial donations given to the Chronic Disease Fund.
As the New Year is approaching The Chronic Disease Fund is working diligently to re-qualify patients for financial assistance for the 2009 calendar year. In order to be considered for continued funding in 2009, patients currently receiving assistance must return the application along with a new verification of household income, signed application and HIPAA authorization.
Applications have been mailed and should be received at the home address by October 31, 2008. Forms can also be downloaded and printed by clicking on the following link:
2009 Re-Enrollment Application
All paperwork must be completed and returned by December 1, 2008. If you need assistance filling out the enrollment information, do not hesitate to contact us toll-free at 877-968-7233. For answers to frequently asked questions regarding our Re-Enrollment Process, please review by clicking the following link:
Frequently Asked Questions
To apply for assistance, please fill out the following form or
Contact Us during normal business hours. If we are unable to answer your call due to call volume, please leave a message and your call will be returned as soon as possible.
You must print out an
Application and HIPAA Authorization
and fax them to
(214) 570-3621
or mail them to:
Chronic Disease Fund
6900 N. Dallas Parkway
Suite 200
Plano, TX 75024
If you cannot print these documents, please fill out the form and we will send them to you.