The forms listed here are for our currently enrolled patients. Please contact us if you have any questions or need assistance. Not yet enrolled? Click here to get started.

Apply For PrEP DAP

Apply for additional PrEP coverage through the Washington State Department of Health’s drug assistance program, PrEP DAP. Our partners at the DOH have created this program to decrease barriers to your care. Renewal is required once yearly. Apply below.

PrEP DAP

Apply for Gilead PAP/Copay Card

The manufacturer of both Truvada® and Descovy®, Gilead, also offers patient assistance. Our team will help you navigate this service and keep track of the variable renewal timelines. Follow the links below to apply and learn more.

Gilead Assistance
Financial Attestation Form

REMS Medication Acknowledgment

Patient safety is our priority. Follow the link to acknowledge your understanding of beginning PrEP.

REMS Form

HIPAA Authorization

We need your permission to communicate with your other medical providers. Follow the link to let us be a part of your healthcare team

HIPAA Form

One-Step PrEP® Patient Intake & Consent Form

Following your initial screening appointment with a Kelley-Ross Pharmacy provider, you will be asked to complete this Patient Intake & Consent form.

PrEP Patient Intake Form

Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

Privacy Practices

Patient Bill of Rights and Responsibilities

This document contains a list of your rights and responsibilities as a Kelley-Ross Pharmacy client.

Patient Bill of Rights

Patient Authorization And Plan Of Service

Important information regarding insurance procedures, patient payment responsibilities, patient rights, and scope of service.

Patient Authorization & Plan Of Service