HIV_AIDS_Prescription_Referral_FormThank you for requesting your digital copy of Avella's HIV / AIDS Rx Form.

Here are just a few of the medications found on this form:

  • ATRIPLA®
  • COMBIVIR®
  • KALETRA®
  • RETROVIR®
  • STRIBILD
  • TRUVADA®
  • VIREAD®

To ensure you receive the most updated referral forms in the future, we request that you submit your contact information. By doing so, we will provide you with the latest version by email.

If you wish to continue downloading, but do not want to provide your contact information, simply click here to access the form.