Enrollment Forms

Using Our Enrollment Forms

Becoming a part of your Neighborhood Specialty Pharmacy is just a click away. Simply find the respective chronic condition below, click to download the enrollment form, fill out the information, and provide it to your region’s Solera Specialty Pharmacy office.

Evzio Injection


Keeping your GI track healthy helps to ensure that your entire body is healthy. Complete our enrollment form so we can assist you in getting the medications you need in order to keep this integral system running properly.

General Therapy

Solera excels in helping patients adhere to the treatment regimens set forth by their physicians. With the information received from our enrollment form, we can provide the support you need to help ensure an optimal treatment outcome

Hepatitis C


With the Solera Specialty Pharmacy Team on your side, HIV/AIDS therapy is comprehensive and easy to follow. Take the steps towards daily management of HIV/AIDS by completing the Solera enrollment form.

PCSK9 Inhibitors

Wound Care - Santyl/Regranex

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