Skip To Main Content

Download the form you need to enroll in MySMA Support™ for Evrysdi.

Start Enrollment With the Evrysdi Start Form

To get started, both you and your doctor must submit this form.

health care provider

You only need to complete page 4. The rest of the form must be filled out by your doctor.

eSubmit View Download
Download Selected 0 files selected Files will be downloaded as .zip file.
  • Complete and submit a form electronically.

By signing Page 4, you allow MySMA Support to talk about your health information with your doctor and health insurance plan.

You can also submit your section of the form online.