To enroll your patient in BioMarin RareConnections™, you must complete the Patient Enrollment Form, which serves as the prescription. Your patient or his/her caregiver must also complete the Patient Authorization Form. Access or download the forms you need to begin enrolling your patient in BioMarin RareConnections.
Patient Enrollment Forms
(to be completed by the healthcare provider)
BioMarin RareConnections HCP Portal
Download and Print
Use this form to start enrollment in BioMarin RareConnections.
*This form serves as the prescription for your patient's BioMarin treatment.
WARNING: Anaphylaxis has been reported after administration of PALYNZIQ and may occur at any time during treatment with PALYNZIQ. Please see the Important Safety Information, including a Boxed Warning for risk of anaphylaxis, and the full Prescribing Information and Medication Guide.
Patient Authorization Form
(to be completed by your patient)