Starting the SpringWorks CareConnections^® Enrollment Process is simple

If you prefer, you can also download and complete a print or PDF version of the form and submit it through fax or email. If you choose to submit the Enrollment Form through fax or email, please follow the steps below:

Step 1

Download the Springworks CareConnections Enrollment Form.

Download PDF

Step 2

Complete and sign the form.

Be sure to include:

Prescription
Prescriber signatures

Please note: Your patient is also required to provide certain information and sign the corresponding authorizations to enroll in the program.

Step 3

Fax the enrollment form to 844-227-3747 or email the form to info@springworkstxcares.com

Have Questions?

Call SpringWorks
CareConnections today

844-CARES-55

(844-227-3755)

Monday-Friday
8 AM-8 PM ET

Field Access
Manager (FAM) Support

For questions about patient access to
GOMEKLI, click to connect with a FAM

OGSIVEO, GOMEKLI, PIMJETMI, and SpringWorks CareConnections are registered trademarks of Merck KGaA, Darmstadt, Germany and/or its affiliates. All other trademarks are the property of their respective owners.

EMD Serono, Inc. and SpringWorks Therapeutics, Inc. are healthcare companies of Merck KGaA, Darmstadt, Germany.

US-GOM-01397 11/26

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