Forms and Documents

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 complete this form.

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

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.