IDAP

You have been invited to complete Foundation for Sarcoidosis Research (FSR) Insurance & Disability Assistance Program (FSR IDAP) referral form.

Based on the information you provided to the FSR, FSR will be referring you over to the Patient Advocate Foundation (PAF) who is managing our insurance and disability support program. The PAF’s case management team will follow up with you directly to assist you with your current insurance or disability related issues.

Though FSR and PAF cannot guarantee that issues will be resolved, please be assured the team will provide you with the best resources we have available to assist you.

*If you were not invited complete this form, please contact FSR at info@stopsarcoidosis.org or 312.341.0500, so we better understand your challenges and direct you to the best resources.*

To assist us with our referral of your case to the PAF, please complete the following form.

Please select one of these options(Required)

Your Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Name of Patient(Required)

First Last

Address(Required)

Please note this program is open to US residents only.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Date of Birth(Required)

To assist us with our referral of your case to the PAF, please complete the following form.

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