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Need Help Getting Medicines? (Self-Referral Application)

If you or someone you know is struggling to pay for prescription medications, Lawson Neel MedBank may be able to help.  If you wish to apply for prescription medication assistance, please call us (229-226-8114 – Ext 120) or use our convenient, online self-referral form.  click here to access form and apply

Self-Referral Application

Thank you for your interest in assistance from Lawson Neel MedBank; we look forward to being able to help you in any way we can.  Please help us by answering every question completely. Required questions will be highlighted in red.

Concerned about privacy? Your information is kept private and is used only for purposes that are clearly identified. Click here to read our Privacy Policy

Application Confirmation.  When you have completed and submitted the online application, you will automatically receive via email a confirmation that your application has been received.  After 3 to 5 business days, you will be contacted by a MedBank volunteer to participate in a telephone interview to complete the application process. 

 

 

APPLICATION FORM GOES HERE…

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