By submitting the above form, I understand that I am requesting Patient Assistance 123 and its representatives to contact me regarding my current prescription costs. They will contact you via phone or email. I understand that Patient Assistance 123 is not an affiliate of any pharmaceutical companies nor can they provide a guarantee of approval for Patient Assistance Programs. The approval is determined by the pharmaceutical companies and Patient Assistance 123 is responsibility for facilitating the exchange of information. Patient assistance 123 are advocates that provide a service facilitating the process and filling out the appropriate paper work from the manufacturing pharmaceutical companies to try and get you approved for their programs. Representatives of Patient Assistance 123 cannot give medical advice or diagnosis. Patient Assistance 123 is here to help you but the responsibility of taking the medication prescribed is solely yours. This information and all information contained in this site is protected under copyright law and any reproduction or dissemination without the owners consent is considered to be a violation of copyright law.
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