Qalsody™ enrollment  form

Complete and submit the form to Optum Frontier Therapies.


QalsodyTM enrollment form


Sending your prescription for Qalsody

To submit a Qalsody prescription, the prescribing provider will need to complete a therapy enrollment form. The form can be downloaded below.

Once the prescriing provider completes and signs the enrollment form, the prescription is ready to submit.

Find more information here on the three ways to send us a prescription.