HCPs Forms
New Provider Attestation Form ABILIFY MAINTENA® (aripiprazole)
New Provider Attestation Form REXULTI® (brexpiprazole)
New Provider Attestation Form for SAMSCA® (tolvaptan)
New Provider Attestation Form for JYNARQUE® (tolvaptan)
New Provider Attestation Form for ABILIFY ASIMTUFII® (aripiprazole)
New Provider Attestation Form for NUEDEXTA® (dextromethorphan HBr and quinidine sulfate)
Refill Request Form
Re-initiation of Therapy Form SAMSCA® (tolvaptan)
Medical Necessity Letter SAMSCA® (tolvaptan)
Income/Insurance/Residency Attestation Letter
Vitamins Request Form