Dompé CONNECT to Care
Access support and more through a single point of contact
Providing practices and patients with assistance every step of the way

Program enrollment

Benefits verification

Prior authorizations

Patient financial assistance

Delivery coordination
& confirmation

General questions
Since approval in 2018, more than 2000 total ophthalmologists and optometrists have prescribed OXERVATE®1
Patient Enrollment
How to enroll a patient
Submit a Patient Enrollment Form
A completed enrollment form serves as the OXERVATE® prescription and enrolls the patient into Dompé CONNECT to Care.
Fax completed enrollment form
on the patient’s behalf.
Use the iAssist digital portal
to complete enrollment.
Remember: Patient Authorization section of enrollment form must be completed.
Questions? Contact Dompé CONNECT to Care