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Signature of Parent, Legal Guardian, or Personal Representative* (or patient if 18 years of age or older) X Date* Patient s Information: Please print clearly.

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How to fill out humira complete ambassador enrollment

How to fill out Humira Complete Ambassador Enrollment:

01

Visit the official Humira website or contact your healthcare provider to get access to the enrollment form.

02

Fill in your personal information accurately, including your full name, address, phone number, and email address.

03

Provide your healthcare information, such as the name of your healthcare provider and any relevant medical conditions or treatments you are currently undergoing.

04

Indicate your interest in becoming a Humira Complete Ambassador by checking the corresponding box on the enrollment form.

05

Review the enrollment form thoroughly before submitting it to ensure all information is correct and complete.

06

Send the filled-out enrollment form to the designated address or submit it through the official online submission process.

Who needs Humira Complete Ambassador Enrollment:

01

Individuals who are currently taking or considering starting Humira treatment for a medical condition, such as rheumatoid arthritis, psoriasis, Crohn's disease, or ulcerative colitis.

02

Patients who want to have access to additional support, resources, and benefits provided through the Humira Complete Ambassador program.

03

Anyone interested in joining a community of individuals who can share their experiences, provide support, and raise awareness about Humira and its impact on their lives.

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