
WELCOME TO MyROCK ASSIST
PROGRAM ENROLLMENT FORM
Find out which services patients may be eligible for by completing this form. Our MyROCK ASSIST Case Managers can determine which programs are available to patients.

ENROLL FOR CO-PAY SUPPORT
For eligible patients with commercial or private insurance plans.

CONTACT US
Our MyROCK ASSIST team is available to help you Monday through Friday,
8 AM-8 PM ET.
Phone: 1-844-523-6661 1-844-523-6661
Fax: 1-833-635-1481 1-833-635-1481