Getting Started | INSUPPORT™ for Patients

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INSUPPORT for Patients
Learn more about how to enroll with INSUPPORT

Getting started is simple

Patient Enrollment Form

In order to initiate any services with INSUPPORT™, you and your healthcare provider must complete the required sections of the form and your healthcare provider will submit the completed Patient Enrollment Form for you.

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).

Patient Authorization and Consent Form

This form is included as a part of the Patient Enrollment Form. Your signed and dated Patient Authorization and Consent Form allows your healthcare provider to share your personal health information with INSUPPORT™ and other listed entities that will assist in completing your service request.

In the event your signature was not captured on the Patient Authorization and Consent Form in your healthcare provider's office, you may download the form and submit it to INSUPPORT™ yourself. Please include your Provider's name and your Patient ID (if known) at the top of the Patient Authorization and Consent page.

Download Patient Authorization and Consent 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™ Patient Portal.

IMPORTANT TO REMEMBER:

Read, understand, sign, and date the bottom of the Patient Authorization and Consent Form, if required. INSUPPORT™ cannot take any action until a written or electronic patient signature has been obtained for the following services: Full Hub Services, Copay Assistance Program, and Alternate Funding Research. You may revoke your consent by contacting INSUPPORT™ at any time. The following services offered by INSUPPORT™ do not require a signed and dated Patient Authorization and Consent: Insurance Verification Only and Denied Claim Research.

The Patient Portal

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

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