ASAP Enrollment form

Please ensure that the application is fully completed and that all supporting documentation is included. Incomplete or missing documentation may result in delays in processing the application. 

You may fax the application to 1-877-801-0777 or mail it to:
 
Allos Support for Assisting Patients
c/o AccessMED, Inc.
6900 College Blvd. Ste 1000
Overland Park, KS 66211

Please call 1-877-ASAP102 (1-877-272-7102) if you have any questions regarding the application or the ASAP program.

Thank you,
ASAP Reimbursement Counselor