Call us 1-800-652-6227
Enroll by Fax or Mail

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Step-by-step Application Instructions
Download Application

Call 1-800-652-6227 and request a patient assistance program application.


Download Application

A Patient Assistance Specialist will fax or mail your patient's application to you.


Download Application

Complete the application.

Complete and sign your portion of the application and have the patient complete and sign their portion.


Download Application

Mail or fax the completed application to the program.

Please submit all four pages of the completed and signed application, along with the tax return (if applicable).

Johnson & Johnson Patient Assistance Foundation, Inc.
Patient Assistance Program
P.O. Box 221857
Charlotte, NC 28222-1857

Or fax the documents to 1-888-526-5168

Please keep a copy for your records.