Getting your patient started with RELiZORB is easy. RELiZORB Support Services will be here every step of the way to help you, and to help your patient start and stay on RELiZORB under your direction.

You and your patient can work together to complete the Patient Enrollment Form, just follow these 3 easy steps:

  1. Ask your patient to fill out the left-hand side of the Form (sections 1-3)
  2. You fill out the right-hand side of the Form (sections 4-6)
  3. Once completed, you simply email or fax the form to RELiZORB Support Services at RelizorbOrder@asembia.com or 1-844-233-3146

Below is a link to a sample Letter of Medical Necessity to request approval for use and subsequent payment of RELiZORB on behalf of your patient. The prescriber must modify the sample letter to be appropriate for the particular patient as the prescriber deems appropriate in his or her professional discretion.

Learn more about RELiZORB Support Services by clicking here.

Questions?
RELiZORB Support Services is here to provide the information you need to help get your patient started on RELiZORB.

1-844-632-9271

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