The Hardship Enrollment Form is an interactive form for the staff of a pharmacy to send to a patient for a signature.
The staff fills out the form, leaving the signature field at the bottom blank.
Afterwards, they send the form to the patient by email, fax, or regular mail.
Then, the patient signs the form and returns to the staff of the pharmacy, and the process is complete.
Use the Hardship Enrollment Form to offer patients an opportunity to pay for their medications at a future date.
This form is a valuable resource for any pharmacy.
PDF is provided as a zip file also containing an image file of the document.