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INSUPPORT® for Patients
Learn more about how to enroll with INSUPPORT®

Getting started is simple

Interested in Enrolling in the INSUPPORT® Copay Assistance Program?

You may work with your healthcare provider to complete enrollment during an in-office appointment.

To Enroll in INSUPPORT®:

Patient Enrollment Form

To enroll in INSUPPORT®, you and your healthcare provider must complete the required sections of the Patient Enrollment Form. This form may be completed and submitted to INSUPPORT® in 2 ways: online or via fax.

Your healthcare provider may enroll you in INSUPPORT® online using the INSUPPORT® Portal. If you are enrolled online, you may receive an email request from your healthcare provider to complete your patient authorization, electronically via DocuSign. INSUPPORT® will begin to process the enrollment request only after your completed form(s) have been received.

You may also work with your healthcare provider to enroll in the INSUPPORT® Program using the paper Patient Enrollment Form. Once all required sections are completed, your healthcare provider must fax all pages of the completed form to INSUPPORT®.

If you choose not to enroll in INSUPPORT®, you can still be treated with PERSERIS® (risperidone) for extended-release injectable suspension. You may choose to enroll or discontinue use of INSUPPORT® services at any time.

Download Patient Enrollment Form

English Form Spanish Form

If you require assistance in other languages, then please call INSUPPORT® at 1‑844‑INSPPRT (1‑844‑467‑7778).

Need help completing the form? See sample form now

Sample Form

Patient Authorization Form

This form is included as a part of the Patient Enrollment Form and exists as a standalone form. Your completed Patient Authorization Form allows your healthcare provider to share your personal health information with INSUPPORT® and other listed entities that will assist in completing your request. You may choose to enroll or discontinue use of INSUPPORT® services at any time.

In the event your Patient Authorization Form was not completed in your healthcare provider's office, you may submit the form to INSUPPORT® in 2 ways: online or via fax.

To submit online, you may use the INSUPPORT® Portal to complete and submit your patient authorization electronically via DocuSign. If your healthcare provider initiates this request, you may also receive an email request from your healthcare provider to complete your patient authorization. Only one completed patient authorization is required. INSUPPORT® will begin to process the enrollment request only after your completed form(s) have been received.

Submit Authorization Online to the INSUPPORT® Portal

To submit your authorization via fax, you may download the stand-alone Patient Authorization Form and you or your healthcare provider may fax all pages of the completed form to INSUPPORT®.

IMPORTANT TO REMEMBER:

You must complete all required sections, sign and date the form, and return all pages to INSUPPORT® in order to enroll in the Program. You may revoke your authorization by contacting INSUPPORT® at any time.

Download Patient Authorization and Form

English Form

If you require assistance in other languages, then please call INSUPPORT® at 1‑844‑INSPPRT (1‑844‑467‑7778).

There are two ways to submit your form: Fax it to INSUPPORT® at 1‑833‑404-4897 or send electronically via the INSUPPORT® Portal.

The INSUPPORT® Portal

The INSUPPORT® Portal allows web-based personal monitoring of case and copay activity, where applicable.

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