Consent Form

Complete Your Consent Form to Begin Accessing YourBlueprint®

After your healthcare provider initiates your enrollment, please provide your consent.

There are two ways to finalize your enrollment listed below. You will need to submit a form that provides your consent and HIPAA authorization.

A series of slightly opaque blue dots arranged in half circle pattern
Icon of pen and paper, signifying an authorization form

Option 1: Online

Complete online with DocuSign®: e-consent & HIPAA authorization form

Please complete and sign the consent and authorization form online through DocuSign®.

Complete online
Icon of postal letter, signifying the printing and mailing of a form

Option 2: Offline

Download form, complete, print & send via e-mail, fax or mail

If you prefer to provide your consent and authorization offline, please download and complete the form. Then send it to the email, fax or mailing address provided on the form.

Download form
Blueprint Logo

You are about to leave the YourBlueprint® website

You will enter a website to sign your consent form to complete your enrollment in YourBlueprint. You must provide your consent and HIPAA authorization to finalize your enrollment in YourBlueprint. You will enter a website that is not owned or controlled by Blueprint Medicines. Blueprint Medicines is not responsible for any information, statements, or other content you may encounter on third-party websites and makes no representation as to the accuracy of information contained on websites we do not own or control. Further, Blueprint Medicines does not recommend nor endorse the content of any third-party website. Your use of a third-party website is subject to the terms and conditions of use for such sites.

Proceed
Blueprint Logo

You are about to leave the YourBlueprint® website

You will enter a website to complete your patient’s enrollment in YourBlueprint. Your patient must provide their consent and HIPAA authorization to finalize their enrollment in YourBlueprint. You will enter a website that is not owned or controlled by Blueprint Medicines. Blueprint Medicines is not responsible for any information, statements, or other content you may encounter on third-party websites and makes no representation as to the accuracy of information contained on websites we do not own or control. Further, Blueprint Medicines does not recommend nor endorse the content of any third-party website. Your use of a third-party website is subject to the terms and conditions of use for such sites.

Proceed
Blueprint Logo

You are about to leave the YourBlueprint® website

You will enter a website that is not owned or controlled by Blueprint Medicines. Blueprint Medicines is not responsible for any information, statements, or other content you may encounter on third-party websites and makes no representation as to the accuracy of information contained on websites we do not own or control. Further, Blueprint Medicines does not recommend nor endorse the content of any third-party website. Your use of a third-party website is subject to the terms and conditions of use for such sites.

Proceed