Enroll your patients today

Help your patients get started on ANDEMBRY

Follow the steps below. We recommend that you print and fill out the form below or start the enrollment process before your patient’s visit in case additional information from their insurance company is requested.

Step 1: 
 

Complete referral form

Step 2: 

use prior authorization checklist

Verify you have the diagnostics that insurers often require.

Step 3: 


submit to ANDEMBRY Connect

Use our electronic form or download and Fax the completed form(s) to ANDEMBRY Connect at 1-866-415-2162.

ANDEMBRY Connect will confirm receipt and may contact you for additional documents requested by the insurer