Get Started

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How to get started with onesource

You can always call OneSource at 1-888-765-47471-888-765-4747 to ask for information or enroll in the program.

To start receiving personalized support from OneSource, you’ll need to complete and submit an enrollment form.

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ONLINE

Complete the patient section of the enrollment form electronically.

Get Started

OR


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ENROLLMENT FORM

Download the form to your computer and fill out the patient section only.

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    Sign

    After youve completed the form, make sure to sign it. This allows us to share your child's health information.

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    Send

    When the form is complete, email it to OneSource@Alexion.com or fax it to 1-8‌00-420-5150.

By completing your enrollment form, you’re providing consent to Alexion to collect your child's specific health information for the OneSource™ patient support program. This includes access to services that can help you navigate your health insurance, continue your child's care while traveling, and understand more about your child's treatment and condition. The program is optional, but this form is needed for Alexion to provide you with support.


Enrollment Form

To begin, select the option that best describes you. From there, we’ll guide you through the process to join the OneSource support program.

All fields are required, unless noted.

Patient’s information:

Please enter your patient's first name
Please enter your patient's last name
Please enter your email

Select your child's condition:

Please select one of the options

Your prescribing doctor’s information:

Please enter your prescribing doctor’s first name
Please enter your prescribing doctor’s last name

An error occurred and your form was unable to be submitted. Please submit the form again.

All fields are required, unless noted.

Prescribing physician’s information:

Please enter your first name
Please enter your last name
Please enter your email

Patient’s information:

Please enter your patient's first name
Please enter your patient's last name

Select patient’s condition:

Please select one of the options

An error occurred and your form was unable to be submitted. Please submit the form again.