Qalsody™ enrollment form
Complete and submit the form to Optum Frontier Therapies.
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.