SyndAccess Offers More Ways to Enroll Your Patients
e-Enrollment Website
Complete enrollment with these simple steps:
- Type information directly into the fields, click through
each section, then review and submit. - SyndAccess will contact your patient after the e-Enrollment form is completed to assist with the e-Consent process.
Patient consent signatures CANNOT be submitted on the
enrollment website.
SyndAccess Enrollment Form
Complete enrollment with these simple steps:
- Type the information directly into the fields on the PDF. Save the file and print it out,
OR
Print it out and manually write in the information.
- Certify healthcare professional and patient consent with signatures.
- Fax the completed Enrollment form to SyndAccess at 1-888-567-3299.
- SyndAccess will contact your patient if there is no signed Consent form. The SyndAccess nurse team can assist patients with the consent process.
All pages, including signature pages, should be submitted to allow for processing. SyndAccess may require additional documentation to assess program availability.
For processing or program questions,
please
call
1-888-567-SYND
(1-888-567-7963),
Monday–Friday, 8 AM to 8 PM ET
Patient Services Team
After enrollment in SyndAccess, our patient services team can work directly with your patients and/or their caregivers and may help support access, affordability, and adherence to treatment.