VIVITROL

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Provider Locator Enrollment Form Help people find your practice so they can learn more about alcohol dependence and treatment. Our online Provider Locator will provide the contact information and street address for your practice, as well as link to online driving directions. If you would like to add your practice to our Provider Locator, please download the enrollment form below. Fill out the one-page form and fax it back. Download the Provider Locator registration form . Note: This form is provided in Adobe ® Reader ® format (PDF). In order to view PDF documents, you must have the free Adobe Reader software installed on your computer. If you do not have the Adobe Reader, download it from the Adobe Web site .

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