Forms and Documents with EASE
Help your eligible patients enroll in Exelixis Access Services (EASE) using the forms and documents for requested programs and services.
EASE Enrollment Form
This form allows you to help request financial assistance or coverage-related information for patients. You can also help enroll your patients with CoverMyMeds®
Patient Authorization Form
This form is for your patients to authorize the use of their health care information in relation to support with EASE. This form can also be signed digitally through DocuSign.
Dose Exchange Program
This form allows you to request CABOMETYX® (cabozantinib) in a lower dose for your eligible patients who require a dose reduction.*†
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Additional restrictions and eligibility rules apply.
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Patients are required to return any unused product.
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CoverMyMeds is a registered trademark of CoverMyMeds LLC.
