THE PRESCRIPTION START FORM

The first step in beginning treatment is for you and your healthcare provider to complete the Prescription Start Form. The Prescription Start Form has 2 sides to it. You, the patient or caregiver, can fill out one side. Your healthcare provider fills out the other side. Once both sides are completed and signed, your provider will fax it to PTC CaresTM to start the prescription process.

You can download the Prescription Start Form here and fill out your side at home, or your provider can download it and you both can fill it out together. Either way, it must be totally completed and signed so that you can begin receiving PTC products as well as PTC Cares support.

Side 1: Patient/caregiver information

image of the caregiver prescription start form

Side 2: Healthcare provider information

Image of Prescription Start Form Caregiver

Download the Prescription Start Form

After your provider has submitted the Prescription Start Form, your personal case manager will call and take you through the easy 5-step prescription process. Be sure to explore our glossary of insurance terms or find answers to common questions you may have in FAQs.

See our easy 5-step prescription process