Immediate Action Required For All Sucraid® Prescriptions
- Completion of consent forms is required for shipment.
- Please make sure your insurance and financial assistance information is up-to-date.
- 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 forms online and submit electronically, click the appropriate link below:
Patient Consent (Under Age 7) – for Parent/Guardian
Patient Consent (Ages 7 to 17) – for Parent/Guardian
Minor Assent (Ages 7 to 17) – for Child
(Please Note: Both Ages 7 to 17 forms above must be completed separately.)
Patient Consent (18 Years and Older)
To download consent forms and patient questionnaire, click the appropriate link below: