Patient & Physician Resources

Patient resources

Solesta Patient Informational BrochureBowel Incontinence Symptom Tracker

Physician resources

ORDERING AND BILLING

Solesta Contact Directory
Solesta Order Form (EVERSANA)
Coding and Billing Instructions for CMS Form 1500

SOLESTA REIMBURSEMENT ASSISTANCE PROGRAM (SRAP)

Solesta Patient Referral Submission Checklist
Solesta Reimbursement Service Request Form (SRF) Letter of Medical Necessity Template - Male Letter of Medical Necessity Template - Female Appeal Template - Male Appeal Template - Female

SOLESTA TEMPORARY REBATE INITIATIVE (TRI)

Solesta Rebate Request Form
Temporary Rebate Initiative Agreement

GENERAL INFORMATION

Solesta Instructions for Use Solesta Pearls Presentation Solesta Pearls VIDEO with Dr. Bernstein

Additional Resources

Solesta brings you these additional resources for valuable fecal incontinence–related information to help support your patients.

The following list is not intended to be all inclusive, but it provides a representative sample of the resources available to you:

• American Academy of Family Physicians
• American College of Gastroenterology
• American Society of Colon and Rectal Surgeons
• American Urogynecologic Society
• Cleveland Clinic
• Fecal Incontinence Trial (FIT) Study
• International Foundation for Functional Gastrointestinal Disorders
• Mayo Clinic
• National Association For Continence
• National Institute on Diabetes and Digestive Kidney Diseases

Note: These websites are neither owned nor controlled by Palette Life Sciences. Palette Life Sciences is not responsible for the content or services on these sites.