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Your Account

Please download the appropriate form based on the status that best describes you.

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LUCENTIS Direct New
Account Setup 1740k
Download the form
and fax it in.
LUCENTIS Direct
Account Update
Form 1638k

Your Account

GETTING STARTED WITH LUCENTIS DIRECT

Complete, sign, and fax the form to: 1-877-329-6737.

NEW TO THE PROGRAM
  • I have never used LUCENTIS Direct. I'd like to create an account.
ORDERED BEFORE, BUT NEW TO ONLINE ORDERING
  • I have a LUCENTIS Direct account and have ordered over the phone.
  • I'd like to set up online ordering.
  • I have a LUCENTIS Direct account and need to make some changes to my account information.
ORDERING AGAIN?

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