Cosentyx enrollment form 2022-2025

1. Click ‘Get Form’ to open the cosentyx enrollment form 2022 in the editor.
2. Begin by filling out the 'Patient Information' section. Enter the patient's last name, first name, middle initial, birth date, and sex. Ensure all fields are completed to avoid delays.
3. Next, provide 'Insurance Information.' Fill in details for primary and secondary insurance, including names, phone numbers, ID numbers, and group numbers. Don't forget to include copies of both sides of the insurance cards.
4. In the 'Patient Authorization' section, read through the terms carefully and sign where indicated. This grants permission for information sharing necessary for processing.
5. Complete the 'Physician Information' section by entering the prescriber's details such as name, contact number, and address. This is crucial for prescription processing.
6. Finally, review all sections for accuracy before submitting your form. Use our platform's features to save or print a copy for your records.

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