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ACTEMRA® (tocilizumab)‎ ALECENSA® (alectinib) Avastin® (bevacizumab) COLUMVI™ (glofitamab-gxbm) COTELLIC® (cobimetinib) ENSPRYNG® (satralizumab-mwge) Erivedge® (vismodegib) Evrysdi® (risdiplam) GAZYVA® (obinutuzumab) HEMLIBRA® (emicizumab-kxwh) Herceptin® (trastuzumab) Herceptin HYLECTA® (trastuzumab and hyaluronidase-oysk) Itovebi™ (inavolisib) KADCYLA® (ado-trastuzumab emtansine) LUCENTIS® (ranibizumab injection) LUNSUMIO™ (mosunetuzumab-axgb) OCREVUS® (ocrelizumab) and OCREVUS ZUNOVO™ (ocrelizumab & hyaluronidase-ocsq) PERJETA® (pertuzumab) PHESGO™ (pertuzumab, trastuzumab, and hyaluronidase-zzxf) PiaSky™ (crovalimab-akkz) POLIVY® (polatuzumab vedotin-piiq) Pulmozyme® (dornase alfa) Inhalation Solution Rituxan® (rituximab) for Rheumatoid Arthritis (RA) RITUXAN® (rituximab) for Oncology Rituxan® (rituximab) for Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA) or Pemphigus Vulgaris (PV) RITUXAN HYCELA® (rituximab/hyaluronidase human) ROZLYTREK® (entrectinib) SUSVIMO™ (ranibizumab injection) TECENTRIQ® (atezolizumab) TECENTRIQ HYBREZA™ (atezolizumab and hyaluronidase-tqjs) VABYSMO® (faricimab-svoa) VENCLEXTA® (venetoclax tablets) XOLAIR® (omalizumab) for subcutaneous use ZELBORAF® (vemurafenib) Oncology Ophthalmology Rheumatology

ACTEMRA® (tocilizumab)‎ ALECENSA® (alectinib) Avastin® (bevacizumab) COLUMVI™ (glofitamab-gxbm) COTELLIC® (cobimetinib) ENSPRYNG® (satralizumab-mwge) Erivedge® (vismodegib) Evrysdi® (risdiplam) GAZYVA® (obinutuzumab) HEMLIBRA® (emicizumab-kxwh) Herceptin® (trastuzumab) Herceptin HYLECTA® (trastuzumab and hyaluronidase-oysk) Itovebi™ (inavolisib) KADCYLA® (ado-trastuzumab emtansine) LUCENTIS® (ranibizumab injection) LUNSUMIO™ (mosunetuzumab-axgb) OCREVUS® (ocrelizumab) and OCREVUS ZUNOVO™ (ocrelizumab & hyaluronidase-ocsq) PERJETA® (pertuzumab) PHESGO™ (pertuzumab, trastuzumab, and hyaluronidase-zzxf) PiaSky™ (crovalimab-akkz) POLIVY® (polatuzumab vedotin-piiq) Pulmozyme® (dornase alfa) Inhalation Solution Rituxan® (rituximab) for Rheumatoid Arthritis (RA) RITUXAN® (rituximab) for Oncology Rituxan® (rituximab) for Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA) or Pemphigus Vulgaris (PV) RITUXAN HYCELA® (rituximab/hyaluronidase human) ROZLYTREK® (entrectinib) SUSVIMO™ (ranibizumab injection) TECENTRIQ® (atezolizumab) TECENTRIQ HYBREZA™ (atezolizumab and hyaluronidase-tqjs) VABYSMO® (faricimab-svoa) VENCLEXTA® (venetoclax tablets) XOLAIR® (omalizumab) for subcutaneous use ZELBORAF® (vemurafenib) Oncology Ophthalmology Rheumatology

Download the form you need to enroll in LUNSUMIO Access Solutions.

Start Enrollment With the Patient Consent Form

To get started, fill out the Patient Consent Form. You can submit this form in 1 of 3 ways:

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Sign a printed form, take a photo and text it to (650) 877-1111

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Send it via fax

Sign a printed form and fax or mail it to us (or give it to your doctor's office to do so)

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Your doctor also has to fill out a form called the Prescriber Service Form. Once we have both these forms, we can begin working with you and your doctor's office. You do not need to fill out anything on the Prescriber Service Form.

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