Healthcare Professional Forms

hcp-white-button-download
New Provider Attestation Form for ABILIFY MAINTENA® (aripiprazole)

/content/dam/otsukapatientassistance/live-assets/hcps-forms/form.pdf

Open

white-button-download

hcp-white-button-download
New Provider Attestation Form for ABILIFY ASIMTUFII® (aripiprazole)

/content/dam/otsukapatientassistance/live-assets/hcps-forms/ABILIFY%20ASIMTUFII%20New%20Provider%20Attestation%20Form.pdf

Open

white-button-download

hcp-white-button-download
New Provider Attestation Form for REXULTI® (brexpiprazole)

/content/dam/otsukapatientassistance/live-assets/hcps-forms/REXULTI%20New%20Provider%20Attestation%20Form.pdf

Open

white-button-download

hcp-white-button-download
New Provider Attestation Form for NUEDEXTA® (dextromethorphan HBr and quinidine sulfate)

/content/dam/otsukapatientassistance/live-assets/hcps-forms/NUEDEXTA%20New%20Provider%20Attestation%20Form.pdf

Open

white-button-download

hcp-white-button-download
New Provider Attestation Form for VOYXACT® (sibeprenlimab-szsi)

/content/dam/otsukapatientassistance/live-assets/hcps-forms/voyxact-new-provider-attestation-form.pdf

Open

white-button-download

hcp-white-button-download
New Provider Attestation Form for JYNARQUE® (tolvaptan) tablets

/content/dam/otsukapatientassistance/live-assets/hcps-forms/JYNARQUE%20New%20Provider%20Attestation%20Form.pdf

Open

white-button-download

hcp-white-button-download
Income/Insurance/Residency Attestation Letter

/content/dam/otsukapatientassistance/live-assets/hcps-forms/PAUS23EUP0014%20OPAF%20Income-Insurance-Residency%20Attestation%20Letter-2023%20APPROVED.pdf

Open

white-button-download

style
cream-white, background-image, hcp-forms
/content/otsukapatientassistance/fragments/supported-medications

style
background-image, offwhite