• Patient Information

  • You have been approved to convert to Asensa Drops. Please fill out the information below. You will no longer need to visit an office for further allergy shots.

    The instructions will display upon completion of the form.

  • Acknowledgement

  • I acknowledge that all refills will cost $200 and must be prepaid prior to vial being shipped. Once Asensa conversion is complete, I will be unable to switch back to allergy shots. I will read all instructions provided prior to my nurse call.