Register – Patient – Startz Support Program

This field is for validation purposes and should be left unchanged.

Welcome to Startz^®, the dedicated Hyrimoz^® (adalimumab) care patient support program.

You have been directed here because you have been prescribed adalimumab by your healthcare professional. To complete your enrolment you will be required to provide some information so that you can access the services that you require.

*Please note that you will need to collect your prescription before you can register.

To get started, please enter the last 4 digits of the barcode on the box of your medication (Hyrimoz).

Barcode – Last 4 Digits*

Name*

Prefix First Last

Date of Birth*

Email*

Mobile Phone*

Password*

Valid passwords must be a minimum of 8 characters and contain at least one uppercase, one lowercase, one number and a symbol (eg. # $ %)

Enter Password Confirm Password

Address*

Street Address Suburb State Postcode

How did you hear about Startz?

My Doctor

My Pharmacy

Please let us know how you found out about Startz. This will provide valuable information that enables us to provide better support and resources to program participants.

Healthcare Professional's Name (if known)

Clinic / Pharmacy Name

Clinic/ Pharmacy Address

Street Address City State Postcode

This field is hidden when viewing the form

HCP Ahpra

Patient Registration Form

Welcome to Startz®, the dedicated Hyrimoz® (adalimumab) care patient support program.

Welcome to Startz^®, the dedicated Hyrimoz^® (adalimumab) care patient support program.