Enrollment Forms

Crohn’s Disease/Ulcerative Colitis

Adobe PDF
Fillable PDF

Dermatology

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Fillable PDF

EVZIO

Adobe PDF
Fillable PDF

General Patient

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Hemophilia & Bleeding Disorders

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Fillable PDF

Huntington’s Disease

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Hepatitis C (Massachusetts Providers)

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Fillable PDF

Hepatitis C (Non-Massachusetts Providers)

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Fillable PDF

HIV / AIDS

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IVIG

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Fillable PDF

Multiple Sclerosis

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Fillable PDF

Oncology

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Otezla START Form

AllCare Plus Pharmacy is part of the preferred pharmacy network for Otezla.

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Rheumatology

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Fillable PDF

TIRF REMS Pain Management

Adobe PDF

Xifaxan

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Fillable PDF