Patient Forms

To help you get started, please view our short video that will walk you through how to apply and what to expect from the process.

https://vimeo.com/1092710352
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Enrollment Application for ABILIFY MAINTENA® (aripiprazole) extended-release injectable suspension

/content/dam/otsukapatientassistance/live-assets/patient-forms/PAUS25EBP0013-OPAF-ABILIFY-MAINTENA-Enrollment-Form-2025.pdf

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Enrollment Application for ABILIFY ASIMTUFII® (aripiprazole) extended-release injectable suspension

/content/dam/otsukapatientassistance/live-assets/patient-forms/PAUS25EBP0016-OPAF-ABILIFY-ASIMTUFII-Enrollment-Form-2025.pdf

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Enrollment Application for REXULTI® (brexpiprazole) tablets

/content/dam/otsukapatientassistance/live-assets/patient-forms/PAUS25EBP0014-OPAF-REXULTI-Enrollment-Form-2025.pdf

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Enrollment Application for NUEDEXTA® (dextromethorphan HBr and quinidine sulfate)

/content/dam/otsukapatientassistance/live-assets/patient-forms/PAUS25EBP0015-OPAF-NUEDEXTA-Enrollment-Form-2025-APPROVED.pdf

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Enrollment Application for VOYXACT® (sibeprenlimab-szsi) injection

/content/dam/otsukapatientassistance/live-assets/patient-forms/VOYXACT%20Enrollment%20Form.pdf

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Enrollment Application for JYNARQUE® (tolvaptan) tablets

/content/dam/otsukapatientassistance/live-assets/patient-forms/JYNARQUE%20Enrollment%20Form.pdf

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/content/otsukapatientassistance/fragments/supported-medications

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