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Download the form you need to enroll in Genentech Access Solutions.

Start Enrollment With the Patient Consent Form

To get started, fill out the Patient Consent Form. You can submit this form in 1 of 3 ways:

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Submit it online

Fill out and submit the form online using eSubmit

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Text a photo

Sign a printed form, take a photo and text it to (650) 877-1111

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Send it via fax

Sign a printed form and fax or mail it to us (or give it to your doctor's office to do so)

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  • Complete and submit a form electronically.