Acthar Enrollment Form - Please fax all pages of completed form to your team at. Web prescription & enrollment form four simple steps to submit your referral. Web submit the acthar referral form via fax or through the provider portal to help your patient get started on acthar gel. Web acthar referral form fax:
Web prescription & enrollment form four simple steps to submit your referral. Please fax all pages of completed form to your team at. Web acthar referral form fax: Web submit the acthar referral form via fax or through the provider portal to help your patient get started on acthar gel.