RX Assistance Financial Evaluation Form

Click here to load this Caspio Cloud Database
CONTACT US
Patient Portal Connect, Inc.
2000 PGA Blvd. Suite 4440
Palm Beach Gardens, Florida 33408
(877) 779-6627
How It Works
FAQ
Contact Us
PAP Medications
PRIVACY POLICY
I acknowledge that by submitting the contact form, I’m authorizing Patient Portal Connect, Inc. to contact me by telephone or email at the telephone number or email address provided. Patient Portal Connect, Inc. is not a Pharmacy nor are we an Insurance Company, we are Advocates that help individuals apply for Patient Assistance Programs offered by manufacturing pharmaceutical companies. Patient Portal Connect, Inc. does not prescribe or handle medication, increase or decrease dosages, or offer medical advice.
​