Prescription and Service Request Form
Complete this 1-page form to enroll your patients in Teva Support Solutions®.

© 2021 Teva Respiratory, LLC. CIQ-41277 03/2021
Complete this 1-page form to enroll your patients in Teva Support Solutions®.
Learn how CINQAIR may be ordered/dispensed.
GET STARTEDFind information on a variety of services, including Benefits Verification, Prior Authorization Support, and Administration Location Assistance.
LEARN MORELearn about the personalized education and training offered by Clinical Nurse Educators.
GET INFOOffers support for patients throughout their CINQAIR treatment journey
Learn more by visiting www.TevaSupportSolutions.com