Our online application is for use by the person seeking HUMIRA® (adalimumab) assistance (the patient). We will ask you to confirm your identity and agree that you have truthfully provided the information requested. We will ask you to electronically sign the application before submitting it. Before you start, please make sure that you have electronic copies of the necessary documents.
If the online application is not right for you, please download a PDF version to print and complete here.