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Please review the following information to help you enroll in The Organon Access Program.
If you are requesting a referral to the Organon Patient Assistance Program, be sure to include all information, including a prescription from your health care provider for TOFIDENCE. Please be sure all signatures are included prior to submitting forms to The Organon Access Program.
Download this form to fill out, print, and fax
This form can be downloaded and printed and requires an original signature. Work with your health care provider to complete the enrollment form.
Please read the accompanying Medication Guide for TOFIDENCE, including the information about serious infections, and discuss it with your doctor. The physician Prescribing Information also is available.