- There is NO application fee and all medications received from Welvista are completely FREE.
- Medications are mailed by US Postal Service to the patient’s home.
- Applications are active for one year, unless the patient receives health insurance during that time.
You MUST print, sign and date the application before sending it in; Your application and supporting documents can be mailed, emailed or faxed to us.
Employer Statement of Income Form
Attestation of Physical Address/Patient Identification Form