Bausch & Lomb Patient Assistance Program 2026

1. Click ‘Get Form’ to open the Bausch & Lomb Patient Assistance Program in the editor.
2. Begin by filling in the Practitioner Name, Address, City, State, Zip, and Fax number. Ensure all details are accurate for smooth processing.
3. In the section regarding the patient, provide their First Name and Last Initial. Confirm that they meet the financial need criteria and are uninsured or have been denied coverage.
4. Attach a completed prescription for an eligible product with the original signature of the prescribing physician. Remember, stamps are not acceptable.
5. Select the appropriate medication from the list provided and indicate the quantity (maximum of one).
6. Review all information for accuracy before submitting. Once complete, you can easily download or print your form directly from our platform.

Start using our platform today to simplify your application process for Bausch & Lomb's Patient Assistance Program!