Create your Lilly cares Application Form from scratch

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Here's how it works

01. Start with a blank Lilly cares Application Form
Open the blank document in the editor, set the document view, and add extra pages if applicable.
02. Add and configure fillable fields
Use the top toolbar to insert fields like text and signature boxes, radio buttons, checkboxes, and more. Assign users to fields.
03. Distribute your form
Share your Lilly cares Application Form in seconds via email or a link. You can also download it, export it, or print it out.

A detailed walkthrough of how to craft your Lilly cares Application Form online

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Step 1: Start with DocHub's free trial.

Visit the DocHub website and register for the free trial. This gives you access to every feature you’ll need to build your Lilly cares Application Form without any upfront cost.

Step 2: Navigate to your dashboard.

Log in to your DocHub account and navigate to the dashboard.

Step 3: Initiate a new document.

Hit New Document in your dashboard, and choose Create Blank Document to craft your Lilly cares Application Form from the ground up.

Step 4: Utilize editing tools.

Place various elements such as text boxes, radio buttons, icons, signatures, etc. Organize these fields to match the layout of your document and assign them to recipients if needed.

Step 5: Modify the form layout.

Rearrange your document in seconds by adding, moving, deleting, or combining pages with just a few clicks.

Step 6: Craft the Lilly cares Application Form template.

Convert your newly crafted form into a template if you need to send many copies of the same document repeatedly.

Step 7: Save, export, or distribute the form.

Send the form via email, distribute a public link, or even post it online if you aim to collect responses from a broader audience.

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Build your Lilly cares Application Form in minutes

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
Contact us
Lilly Cares Foundation Patient Assistance Program (Lilly Cares) is a nonprofit charitable organization that provides prescribed Lilly medications for free for up to 12 months to qualifying U.S. patients.
You may learn more about Lilly Cares by accessing the website at or by calling 1-800-545-6962, Monday through Friday, 9 AM to 5 PM ET.
Once youre enrolled in a Trulicity patient assistance program, well continue to serve as your advocate. Well make sure your Trulicity prescription is renewed as needed, and we can help you find assistance for any new medications your doctor may prescribe as well.
Lilly Cares is not affiliated with third parties that charge for assistance that Lilly Cares provides to you at no cost. For support, please call Lilly Cares at 1-800-545-6962. For more information about Lillys privacy practice, please see the Privacy Statement.
How do I check the status of my Lilly cares application? I may call Lilly Cares at 1-800-545- 6962 for this information.
be ready to get more

Build your Lilly cares Application Form in minutes

Start creating now

Related Q&A to Lilly cares Application Form

For support, please call Lilly Cares at 1-800-545-6962.
(1-800-545-5979). 3 Consult with your healthcare provider to confirm delivery location. Infused medications are not eligible for home delivery. 4 When processing your application, you may be contacted by Lilly Cares to provide documentation showing your income.

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