To enroll in ENcourage Foundation®, patients must submit the Patient Application Form and have their physicians complete the Product Prescription Form or submit an original script.
Once a completed application and any requested supporting documents have been received and processed, the patient and provider will be notified of the enrollment decision. Missing information or an incomplete application will delay an enrollment decision.
Eligible patients are enrolled for a period up to 12 months. To re-enroll in ENcourage Foundation®, patients must submit a new application.
Once a patient has been enrolled, they will be contacted by ENcourage Foundation® to provide consent for shipment.
Click here to check eligibility requirements.
Click here to download a patient application or a product prescription form.
Click here for tip sheets to help with the application process and obtaining product refills.
Disclaimer: ENcourage Foundation® reserves the right to make an independent determination of eligibility in all cases. ENcourage Foundation® also reserves the right to approve or deny any ENcourage Foundation® application or to modify or discontinue the program with respect to any patient or provider, or in its entirety, at any time.