New NASH patient enrollment is easy

All new NASH patients must fill out the Patient Information, HIPAA and Informed Consent, and Medical Records Release forms.

To start patient enrollment,  select the Patient Information Form below. Fill out all the fields, click “submit” at the bottom of the completed form. Repeat this until all forms are submitted. Next, the NASH Patient Care team will review for completeness and contact you with next steps!

All patient forms are available in English and Spanish. Simply select the drop-down menu in the right-hand corner of the form to change to your preferred language.

Patient enrollment forms

Patient Information Form

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HIPAA Informed Consent Form

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Medical Records Release Form

Start form
Patients value their NASH experience
My experience with NASH has been really, really good.
Satisfied NASH Patient
NASH knows what they’re doing. The personnel is great, the expertise is great. You’re well taken care of – it’s just almost like they know what you need before you know what you need.
Satisfied NASH Patient
I cannot say enough good things about the service and support I received from NASH.
Satisfied NASH Patient
I think you get more one-on-one here… it’s like I was the only patient that they had to take care of.
Satisfied NASH Patient
NASH has been a great benefit … I feel safe and get the exact same medication.
Satisfied NASH Patient

Contact our patient care team with your enrollment questions.

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