Get Certification Form: Free Auto ... - Bioridge Pharma

This guide provides detailed instructions for successfully completing the Certification Form for the Free Auto-Injector EpiPen4Schools Program offered by Bioridge Pharma. Follow the steps outlined below to ensure accurate submission of the form.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the 'School/School District Name' field with the official name of the school or district applying for the program.
3. Provide the 'School Address,' including street address, city, state, and zip code to ensure proper identification and communications.
4. Enter the 'School Phone' number, ensuring it is a number where the school can receive communications regarding the order.
5. Complete the fields for 'Authorized School Signatory Name,' 'Authorized School Signatory Title,' and 'Authorized School Signatory E-mail,' ensuring that the person signing has the authority to make the certification.
6. Sign and date the form in the designated spaces to confirm that the information provided is true and accurate.
7. In the section regarding quantity, input the number of 2-Pak and/or Jr 2-Pak units you wish to order, keeping within the limits specified.
8. Carefully review all entries for accuracy and completeness before finalizing your submission.
9. Fax the completed Certification Form and a copy of a valid Auto-Injector prescription to Bioridge Pharma, or scan and email the documents to the provided email address.

Complete and submit your documents online to secure your Auto-Injectors for the school.