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Patient Assistance Program Patient (or Legal Guardian) Instructions Form will be returned if information is incomplete. Incomplete forms will delay the application review process. Gross Monthly Household

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What is vimpat trial card?

The vimpat trial card is a program that offers cost savings for patients prescribed with Vimpat, a prescription medication for the treatment of partial-onset seizures in patients with epilepsy.

Who is required to file vimpat trial card?

Patients prescribed with Vimpat are required to file the vimpat trial card in order to access the cost savings benefits of the program.

How to fill out vimpat trial card?

To fill out the vimpat trial card, patients need to provide information such as their personal details, healthcare provider's information, and prescription details. This can be done online through the official website of the vimpat trial card program or by calling the program's customer service.

What is the purpose of vimpat trial card?

The purpose of the vimpat trial card is to provide cost savings for patients prescribed with Vimpat, making the medication more affordable and accessible.

What information must be reported on vimpat trial card?

The vimpat trial card typically requires patients to report their personal information (such as name and contact details), healthcare provider information, prescription details, and any other additional information requested by the program.

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