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ARCH Patient Assistance Program Application Form Page 1 of 2 Please return completed application and all required documentation to ARCH, PO Box 29061, Phoenix, AZ 85038 or Fax to 18772291421PROVIDER

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2. Start by gathering all the necessary information and documents that are required to fill out the application.
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4. Fill in each section or field of the application accurately and truthfully.
5. Double-check all the information you have entered for any errors or omissions.
6. Attach any supporting documents or evidence that may be required with the application.
7. Review the completed application once again to ensure everything is filled out correctly.
8. Sign the application at the designated places, if applicable.
9. Submit the completed application by the specified method or to the appropriate authority.
10. Keep a copy of the completed application and any supporting documents for your records.
11. Follow up if necessary to track the progress of your application or to receive any updates or notifications.

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