Counsel & Enroll Patients

Before enrolling, patients can use the Quick Start Guide and Brochure for Pediatric Patients and Their Caregivers below to find out more concerning the use of XYREM.

Enroll Patients

Choose one of the two methods described below. Complete your application and submit it to the Certified Pharmacy for processing.

Two Ways To Enroll Patients

Online

If you begin patient enrollment online, your patient will receive an e-mail to complete his/her portions of the form, including an e-signature. Then, you will submit the form to the Certified Pharmacy. Both you and your patient will be notified when enrollment in the program is successful.

Frequently Asked Questions

Submit Form Online
Begin Enrollment

Simply enter your name and e-mail to begin your online enrollment.
* = Required Fields

DocuSign makes enrollment easy. By using DocuSign, the XYREM® REMS can ensure that your personal information can stay safe, secure, and protected.