The TOUCH® Patient Enrollment Form and TYSABRI® Start Form are required to start a patient on TYSABRI. Based on the form(s) selected below, each required signer will receive an email(s) from DocuSign to complete their portion of the form.
1. To initiate the process of submitting TOUCH enrollment and TYSABRI start forms electronically, please enter your name and email in the Provider section.
Provider: The HCP representative or office staff responsible for completing the TOUCH Patient Enrollment Form and TYSABRI Start Form, including prescriber and patient information sections
2.Next, fill in the name and email for each signing role listed below. Signers will receive an email inviting them to sign this document(s).
Prescriber: The HCP responsible for enrolling the patient and signing the prescription on the TYSABRI Start Form
Patient (or personal representative): The patient being prescribed therapy and responsible for completing and signing the patient sections on the TOUCH Patient Enrollment Form and TYSABRI Start Form
3. Please select the form(s) needed for this Patient and Prescriber. The Patient and Prescriber will receive emails for corresponding items selected.
Note: The Provider (the HCP Representative or office staff) will be required to fill in and submit the Patient and Prescriber information, and then the Prescriber followed by the Patient will receive an email from DocuSign to complete and sign their sections of the form.
Note: The Prescriber must complete or have completed the TOUCH Prescriber Enrollment Form before any additional forms can be processed. If the Prescriber is already enrolled in the TOUCH Prescribing Program, there is no need to submit this form.
For Important Safety Information and full Prescribing Information, including Boxed Warning and Medication Guide, please see www.TYSABRI.com.
TYS-US-3952 v3 04/23