Get Started

How to get started with onesource™

You don't have to be enrolled in OneSource™ to get information—simply call 1-888-765-47471-888-765-4747 to ask questions.

If English is not your preferred language, we will connect with you through one of our interpreters to make sure you get the support you need.

Ready to enroll in the program for personalized support from OneSource™?

Please choose one of the following options:

Complete and submit a OneSource™ form

To begin, select the option that best describes you. We'll guide you through the process for enrolling in the OneSource™ support program.

icon-patient

I am a patient or legal representative
icon-doctor

I am a prescriber

All fields are required unless noted.

Patient information:

Please enter your first name
Please enter your last name
Note: Completed form will be sent to this email address.
Please enter your email

Select your child's condition:

Please select one of the options

I AM A...

Please select one of the options

Your prescribing doctor’s information:

Please enter your doctor’s first name
Please enter your doctor’s last name
Please check the box to continue

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

Make sure you click the FINISH button before closing Adobe Sign to send your form to OneSource™!

All fields are required unless noted.

Prescribing physician’s information:

Please enter your first name
Please enter your last name
Note: Completed form will be sent to this email address.
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.

Make sure you click the FINISH button before closing Adobe Sign to send your form to OneSource™!

OR

Download and submit A OneSource™ Form

Download and fill out the form that applies to you.

Patient Form (English) Patient Form (Spanish) Prescriber Form
  • sign-icon

    Sign

    After you’ve completed the form, make sure to sign it. This allows us to share required health information.

  • send-icon

    Send

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

For caregivers: 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 child's health insurance, continue 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.