Immediate Action Required For All Sucraid® Prescriptions

To download consent forms and patient questionnaire, click the appropriate link below:

To complete and electronically submit consent forms and patient questionnaire online, click the appropriate link below:

Patient Consent (Under Age 7)

Patient Consent (Ages 7 to 17) for Parent/Guardian

Minor Assent (Ages 7 to 17)
(Please Note: Both Ages 7 to 17 forms above must be completed separately.)

Patient Consent (18 Years and Older)

Physician’s Acknowledgment

Patient Questionnaire (After Taking Sucraid® Lot A1150)

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QOL Medical, LLC