Welcome to the new FlexForward Portal!

Phone: 1-844-353-9466

Fax: 1-866-558-7939

FlexForward Enrollment

Welcome to the FlexForward enrollment page. To submit an enrollment request, please fill in as much detail as possible about your practice and doctors. All fields marked with an asterisk (*) below are required. All information provided will be stored in your browser session and will be automatically deleted when your session expires (after there has been no action in at least 15 minutes). FlexForward uses the information you submit on this form to process your enrollment request. By clicking on the "Submit Enrollment" button below, you agree that the information you provide will be governed by our site Privacy Policy.

NPI

Input a provider or practice NPI and we'll see if we can find the rest!

Practice

User

Prescriber

For more information, please visit www.zilrettapro.com or call 1-855-793-9727. You are encouraged to report negative side effects of prescription drugs to FDA; visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Zilretta

©2024 Pacira Pharmaceuticals, Inc., a wholly owned subsidiary of Pacira BioSciences, Inc. ZILRETTA and FlexForward are registered trademarks of Pacira Therapeutics, Inc., and iovera° is a registered trademark of Pacira CryoTech, Inc., both of which are wholly owned subsidiaries of Pacira BioSciences, Inc. PP-ZA-US-0756 April 2024