Enrolling in LIBTAYO Surround is the first step to accessing support services

Click here for more information about how LIBTAYO Surround can help support your patients.

There are 2 ways you can help patients enroll
Online Enrollment Option


through the LIBTAYO Surround Provider Portal

You can help patients enroll in LIBTAYO Surround and complete important tasks online

Online enrollment
  • You can help patients enroll online, without additional paperwork or faxes
All-in-one repository
  • Centralized patient information to easily track each patient’s treatment journey
Support resources
  • Direct access to LIBTAYO Surround resources, links, and forms
  • Alerts and notifications related to the treatment journey
Patient data protection
  • Password protection ensures access only to HCPs and permitted staff
Click here to access the Provider Portal
Download, Print and Fax LIBTAYO forms

Download, complete, and submit

You can download, complete, and sign the LIBTAYO Surround Enrollment Form with your patients and submit it by:

  • Faxing to 1.833.853.8362
  • Uploading through LIBTAYO Surround DocuSend at patientsupportnow.org (code 8338538362)

Please make sure you and your patients sign where indicated on the forms.

  • Call LIBTAYO Surround at 1.877.LIBTAYO (1.877.542.8296) Option 1, Monday–Friday, 8 AM–8 PM Eastern time
  • Contact your local Reimbursement Manager for assistance