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Our Location

Patient Advocate Foundation
Co-Pay Relief Program
421 Butler Farm Road
Hampton, Virginia 23666

Toll Free 1-866-512-3861
Local: 757-952-0118
Fax: 757-952-0119

 

Contact The Co-Pay Relief Program

View the CPR Corporate Brochure     View Our Frequently Asked Questions

Our counselors are here to assist patients and providers with the Co-Pay Relief Program.

Your question may already be answered in our Frequently Asked Questions section. If your question was not answered or you need more information and help, please enter your request in the form below.

Please provide us with your first name.
Please provide us with your last name.
Please enter a phone number and area code at which you can be reached.
Enter a valid email address at which we can contact you.
Please verify your email to ensure that it is correct and matches the one above.
Is the patient seeking treatment for their condition currently insured?
What is the disease or illness of the patient for which you or the patient are seeking treatment?
Please provide us with an explanation as to why the patient is seeking treatment for this particular disease in 250 words or less.
Please describe your relationship to the patient.
Please attach any images or files relevant to your situation here.