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.

The Enrollment Form can also be downloaded in either English or Español, completed and faxed back to 1-844-901-3273.

This form is for your patients to authorize the use of their health care information in relation to support with EASE.

The Patient Authorization Form can also be downloaded in either English or Español, signed and faxed back to 1-844-901-3273.

This form allows you to request CABOMETYX® (cabozantinib) in a lower dose for your eligible patients who require a dose reduction.^*†

The Dose Exchange Form can also be download, in either English or Español, completed and faxed back to 1-844-901-3273.

Have questions about enrolling your
patient in EASE?

Our team is here to help.

Contact us at 1-844-900-EASE
(1-844-900-3273)

We’re available Monday - Friday
8:00 AM to 8:00 PM (ET)