Welcome to the Patient Authorization & Agreements forms page for Enzyvant CONNECT.
If an Enzyvant CONNECT Patient Enrollment Form has been completed and submitted to Enzyvant CONNECT (by fax, mail, or phone), but you were unable to sign it, you may use the abbreviated form below to provide your signature electronically, so that we can process the Patient Enrollment Form that you or your healthcare provider previously submitted.
1. Click the link below to complete the steps for your eSignature.
2. You will need to provide the following information: First Name, Last Name, Date of Birth, ZIP Code
Dedicated Patient Access Specialists can explain the features and benefits of Enzyvant CONNECT. Learn more about programs for eligible patients who are insured, underinsured, and uninsured.
Talk one-on-one live with a dedicated Patient Access Specialist. (844)-369-2628 (toll free) Monday – Friday, 8AM – 8PM (EST) Multilingual options available.