


The Enrollment Form may not load properly in all browsers. If you are having trouble viewing this document, please contact Catalyst Pathways at 1-833-422-8259.
Please note: Both pages 1 and 2 of the form must be signed by the physician and patient in order for the patient to be eligible for Catalyst Pathways services and financial programs. The physician is required to fax the signed Enrollment Form to Catalyst Pathways at 1-833-422-8260.
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