Patient & Physician Resources

GENERAL INFORMATION

Solesta Instructions for Use
In addition, paper copies of the Solesta IFU may be requested by calling (844) 350-9656 . A paper copy will be provided to the requestor within 72 hours.

Solesta Pearls Presentation Solesta Pearls VIDEO with Dr. Bernstein

Patient resources

Solesta Patient Informational BrochureBowel Incontinence Symptom Tracker

Physician resources

ORDERING AND BILLING

Solesta Contact Directory
Solesta Order Form (EVERSANA)

SOLESTA REIMBURSEMENT ASSISTANCE PROGRAM (SRAP)

SRAP PROCESS OVERVIEW
SRAP PATIENT ENROLLMENT CHECKLIST
SRAP PATIENT ENROLLMENT FORM (PEF) Letter of Medical Necessity Template - Male Letter of Medical Necessity Template - Female Appeal Template - Male Appeal Template - Female

SOLESTA TEMPORARY REBATE INITIATIVE (TRI)

TRI PROCESS OVERVIEW
Solesta Rebate Request Form
Temporary Rebate Initiative Agreement

PATIENT ASSISTANCE PROGRAM (PAP)

PATIENT ASSISTANCE PROGRAM (PAP) ENROLLMENT FORM

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.