FAX: (844) 678-8444 --2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by filling out the 'LICENSED HCP' section. Enter your name, DEA number, NPI, phone number, and address accurately.
  3. Next, complete the 'PATIENT NAME' section. Provide the patient's full name, date of birth, address, city, state, phone number, gender, and email.
  4. In the 'EMBEDDED PRESCRIPTION' section, specify the medication details for each dose prescribed. Include medication names, strengths, instructions for use, quantity needed, refills requested, and the date written.
  5. Finally, ensure that both HCP signatures are provided at the bottom of the form before submitting it via fax to (844) 678-8444.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
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Register at QsymiaEngage.com, locate your prescription and then complete your order. Please allow up to 24 hours for your prescription to be loaded into the system. Track your order online after it ships. Please allow 5-7 business days for delivery (includes processing and shipping time).
The number for your doctor to fax a prescription to Accredo is 888-302-1028.
For patients with new specialty medication prescriptions, your physician can send any specialty medication order directly to Accredo, or you can contact Accredo at 833-721-1622 and we will work with your doctor on the rest. Once received, Accredo will call you to begin the process of scheduling your first order.
If you are out of refills, your doctor can fax a new prescription to Accredo at 888-302-1028.