Multiple Sclerosis HUB Forms
Find your multiple sclerosis (MS) specialty medication and download the appropriate HUB enrollment form, then send to us by fax once completed. To streamline this process, we encourage you to e-prescribe by searching for AcariaHealth in your e-prescribe software.
Branded Referral Forms
Download forms with AcariaHealth contact information and branding that can be used in states other than Alabama, Arizona, Arkansas, Colorado, Connecticut, Illinois, Louisiana, Massachusetts, Minnesota, New Mexico, Pennsylvania, Rhode Island, South Dakota, Vermont, Virginia, West Virginia, Wisconsin and Wyoming
Unbranded Referral Forms
Download forms without any branding or pharmacy information for prescribers in Alabama, Arizona, Arkansas, Colorado, Connecticut, Illinois, Iowa, Louisiana, Maryland, Massachusetts, Minnesota, New Mexico, Pennsylvania, Rhode Island, South Dakota, Vermont, Virginia, West Virginia, Wisconsin and Wyoming