Pfizer oncology together enrollment form 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin with the Patient Information section. Fill in your name, date of birth, sex, address, and contact details. Ensure all required fields marked with an asterisk are completed.
3. In the Insurance Information section, provide details about your insurance coverage. If applicable, fax a copy of your insurance and prescription cards as instructed.
4. Complete the Patient Financial Information section by indicating your total household income and attaching necessary documentation to support your claims.
5. If opting for personalized patient support, check the appropriate box in Section 5 to request Care Champion assistance.
6. Sign and date the Patient Privacy and Consent section to authorize communication regarding your enrollment status.
7. Finally, review all sections for accuracy before submitting the form via fax or mail as indicated at the top of the document.

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