CORE Program is a confidential service sponsored by Cephalon, Inc 2026

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  1. Click ‘Get Form’ to open the CORE Enrollment Form in the editor.
  2. Begin by filling out the patient information section. Enter the patient's name, date of birth, and contact details clearly.
  3. Complete the financial information section with accurate income details. Attach proof of income as required.
  4. In the insurance information section, list all relevant policies and ensure you upload copies of insurance cards (front and back).
  5. Obtain signatures from both the patient/legal guardian and physician in their respective sections to validate the form.
  6. For expedited processing, fax the completed form to 1-866-676-4073 or mail it to the provided address.

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