Patient Assistance Form

Baylor Genetics abides by the contractual and legal obligations of health benefit plans to collect charges, co-pay, co-insurance, and deductible amounts owed by patients. Baylor Genetics recognizes that circumstances may arise where an individual is unable to pay. We adopted a process of screening requests for delayed payment plans, discounts, or forgiveness of debt based on individual circumstances. This patient assistance program is our commitment to work with patients and assure that necessary genetic testing can be provided at a reasonable cost for those with a financial need or for those who are under insured. Baylor Genetics will calculate your financial need based on your annual adjusted gross income and the number of family members in your household.

To download the Patient Assistance form, click here.

1Patient Information
2Patient Attestation
3Supporting Documentation/Notes

Patient Information

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