Forms & Resources

Forms and resources

Enrollment Initiation Icon
If you are looking for forms and information, you are in the right place
If you have not yet finalized your enrollment in YourBlueprint® with your healthcare provider, complete the process today by providing your consent and HIPPA authorization online (facilitated through DocuSign).

E-consent and HIPPA authorization form

If you would prefer not to provide your consent and HIPPA authorization online, you can simply complete this form and send it to the email, fax, or mailing address provided on the consent form.

Consent and HIPPA authorization form

Tell a family member or friend about YourBlueprint: print an overview of the services and support we offer.

Program overview

Question Mark Icon

YourBlueprint is just a call away. Take a look at some of the questions we are most frequently asked:

How do I enroll in YourBlueprint?

Once you have been prescribed a Blueprint Medicines therapy, your healthcare provider can enroll you into the program. To complete your enrollment, you will need to provide your consent and HIPPA authorization in-office, online (facilitated through DocuSign), or in writing. If you choose to provide your consent in writing, you can send your completed form via:

What can I expect once I enroll?

Once you enroll in YourBlueprint, you will be contacted by your dedicated Case Manager who will provide ongoing support to you throughout treatment depending on your specific needs. Please be on the lookout for a call from 1-888-BLUPRNT (1-888-258-7768).

Who is on my YourBlueprint support team?

Your dedicated team includes a Case Manager and Patient Navigator, who are here to provide support with getting on your prescribed therapy and ongoing support once you are on therapy. Meet your team to learn more about how they can help throughout your treatment journey.

How much does YourBlueprint cost?

YourBlueprint is a free resource for patients who have been prescribed a Blueprint Medicines therapy.

How do I know if I’m eligible for financial assistance?

YourBlueprint can help you figure out what help is available for you. Contact YourBlueprint at 1-888-BLUPRNT (1-888-258-7768) to learn about your options.

Is there financial assistance for people with government insurance (Medicare, Medicaid, and VA/DoD)?

Patients with government insurance are not eligible for the Co-Pay Assistance Program. Contact YourBlueprint at 1-888-BLUPRNT (1-888-258-7768) to learn about other potential options.

Whom should I contact if I have side effects?

You should contact your healthcare provider immediately if you are having any side effects. You may also contact Blueprint Medicines at 1-888-BLUPRNT (1-888-258-7768) or the Food and Drug Administration (FDA) at 1-800-332-1088 to report any side effects.

How can I opt out of receiving support through YourBlueprint?

If you no longer wish to receive support from YourBlueprint, you can opt out by calling 1-888-BLUPRNT (1-888-258-7768), emailing info@yourblueprint.com, or sending a letter to PO Box 15590, Pittsburgh, PA 15244.

Beyond YourBlueprint, take a look at outside resources that support people with cancer and their families:

These advocacy groups are included as a reference for patients, and do not imply endorsement of the company or its products by the groups listed. Blueprint Medicines is not affiliated with and does not endorse any particular advocacy group. We make no guarantees about the accuracy of the information provided on advocacy groups’ websites or the quality of support provided. Descriptions of advocacy group resources and activities have been provided by the independent advocacy groups.