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This section of the website is for Advocate use only; unless you are a healthcare worker acting as an Advocate, this section will not be of assistance to you. For patient information, please visit the Program Description, where you will find a full description of the Program and its benefits.
Obtain Enrollment Forms
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An Advocate must registered with our program to access patient enrollment forms. The Advocate Sign In box on the left provides links for registering and signing in. Registered advocates can sign in with their User ID and Password to access the enrollment forms which can be completed online or printed for use at a later time.
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NOTE: Each form has a unique identification number, so each Patient will need an original numbered enrollment form. If you need multiple forms, please "refresh" your screen to generate a new identification number for each form that you wish to print. Forms may not be photocopied for use with multiple Patients.
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Enrollment forms may also be ordered on this page for receipt by mail, or, if you prefer, you may call Commitment to Access at 1-8-ONCOLOGY-1 (1-866-265-6491) to request forms by mail or fax.
Reenrollment
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When a Patient requires re-enrollment after one year in the program, the Advocate will receive a Patient-specific letter with information about how to continue the Patient in the program. A patient specific enrollment form will be sent to you before your Patient's initial enrollment period has expired. If the Patient-specific re-enrollment form is lost, an Advocate can use another form, but must cross out the identification number and write in the Patient's identification number.
Enrollment Process
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