Forms & Resources
Forms and resources
If you have not yet finalized your enrollment in YourBlueprint™ with your healthcare provider, complete the process today by providing your consent online (facilitated through DocuSign).
If you would prefer not to provide your consent online, you can simply complete this form and send it to the email, fax, or mailing address provided on the consent form.
Tell a family member or friend about YourBlueprint: print an overview of the services and support we offer.
YourBlueprint is just a call away. Take a look at some of the questions we are most frequently asked:
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 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:
- - Email: email@example.com, or
- - Mail: PO Box 15590, Pittsburgh, PA 15244
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.
YourBlueprint is a free resource for patients who have been prescribed a Blueprint Medicines therapy.
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.
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.