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Get started with the enrollment process

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A few answers to get started


If you need to get a prescription for your patient, fill out the treatment form.

If you need long-term care access services, fill out the long-term care service request form.

treatment form, icon
long-term care request form, icon

You can complete the form through the form fields below (recommended), or download the PDF version of the long-term care form and fax it to 1-844-737-2224.

Complete the long-term care service request form in just 5 steps:

Step 1:
Resident Information

All information required unless marked optional

Preferred Contact Time (optional)

Resident Signature/Legal Guardian HIPAA Authorization (optional)

By signing this authorization, I authorize my health plans, physicians, and pharmacy providers to disclose my Protected Health Information (“PHI”), including, but not limited to, information relating to my medical condition, treatment, care management, and health insurance, as well as information provided on this form and any prescription to ACADIA Pharmaceuticals Inc. (“ACADIA”) and its representatives or agents, including ACADIAʼs NUPLAZIDconnect Support Center operated by The Lash Group, Inc. on behalf of ACADIA

You can complete the form through the form fields below (recommended), or download the PDF version of the treatment form and fax it to 1-844-737-2224.

Complete the treatment form in just 5 steps:

Step 1:
Patient Information

All information required unless marked optional

Patient HIPAA
Signature (optional)

By signing this authorization, I authorize my health plans, physicians, and pharmacy providers to disclose my Protected Health Information (“PHI”), including, but not limited to, information relating to my medical condition, treatment, care management, and health insurance, as well as information provided on this form and any prescription to ACADIA Pharmaceuticals Inc. (“ACADIA”) and its representatives or agents, including ACADIAʼs NUPLAZIDconnect Support Center operated by The Lash Group, Inc. on behalf of ACADIA
CLEAR
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Questions? Connect with a NUPLAZIDconnect representative.

1-844-737-2223
Monday through Friday
8:30 AM-8:30 PM EST

For healthcare professionals