Get Ambassador Form

Filling out the ambassador form online is a straightforward process that allows users to enroll in Complete. This guide provides clear, step-by-step instructions to ensure that you can complete the form with ease.

Follow the steps to successfully complete the ambassador form online.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by providing the prescriber’s information. Fill in the prescriber’s name, address, city, state, zip code, phone number, and fax number. Make sure to check the appropriate dose of for the patient at the top portion of the form.
3. The prescriber must sign and date the form. Ensure to use an original signature and avoid stamps.
4. Next, provide the patient’s information. Fill in their first name, last name, gender, address, date of birth, phone number, email address, and the best time to call.
5. The patient should check the box indicating whether it is permissible to leave a message when calling.
6. Select the medical condition(s) applicable to the patient by checking the relevant boxes associated with conditions including rheumatoid arthritis or ankylosing spondylitis.
7. Authorize AbbVie and its partners to use the personal information provided by signing the authorization statement. Ensure the patient understands the implications of this consent.
8. The patient must then sign and date the form at the designated section.
9. Finally, once all sections are completed and signed, save the changes. You can then download, print, or share the completed form as necessary.

Complete your ambassador form online today to ensure you receive the support you need.