How to Enroll Your Patients

To enroll a patient diagnosed with Primary Periodic Paralysis in ORMALVI (dichlorphenamide) tablets simply click the download form button below. Print the enrollment form, complete all required fields and either fax the form to Cycle Vita™ at + 1 (888) 385-8482 or email it to hello@cyclevita.life.

Download form

If you have any questions the Cycle Vita team is only a phone call away.

A friendly, familiar team is waiting here at Cycle Vita, for you, at every step.
Cycle Vita Logo With Strapline
Cycle Vita Logo With Strapline
A friendly, familiar team is waiting here at Cycle Vita, for you, at every step.

+1 (888) 360-8482

*Some areas of support may not be accessible to all patients. Eligibility criteria may apply to ensure compliance with all applicable federal and state requirements, and benefits may be limited to commercially insured patients only. For more detailed information about eligibility, terms and conditions, please contact the Cycle Vita team at +1 (888) 360-8482