This site is for US residents only. For Non-US Residents

Immediate Action Required For All Sucraid® Prescriptions

  1. Completion of consent forms is required for shipment.
  2. Please make sure your insurance and financial assistance information is up-to-date.
  3. To coordinate your Sucraid® shipment or for questions, contact SucraidASSIST at 1-800-705-1962 Monday through Friday 8:30 a.m. – 5:30 p.m. (EST).

To complete and electronically submit consent forms online, click the appropriate link below.

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

QOL Medical, LLC

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