Actemra® (tocilizumab)

Please print and complete one of the following forms below. Once completed, fax to the number indicated on the form.

Referral forms available for Actemra® (tocilizumab):

• Actemra® (tocilizumab) Intravenous Referral Form
• Actemra® (tocilizumab) Subcutaneous Referral Form