Tonmya Together<sup class="tm">TM</sup> Savings Program

GET MY SAVINGS CARD

First, we need to verify that you are eligible for the Tonmya Together^TM Savings Card. Please fill in the information below. Items marked with (*) are required.

Eligibility Questions

Are you 18 years of age or older? *

Yes

Is your prescription covered in whole or in part by any governmental program, including Medicare, Medicaid, TRICARE, Department of Defense, Veterans Affairs or any other federal or state government healthcare or pharmaceutical assistance programs providing prescription drug benefits? *

Yes

Patient Information

First Name *

Last Name *

Address *

Address 2

City *

State *

Zip Code *

Email Address *

Verify Email Address *

By providing your mailing and email address above, you agree and acknowledge that you would like to receive communications from Tonix Medicines, Inc. related to Tonmya Together^TM Savings Program. The information pertaining to you that we collect will be used in accordance with our . If you later wish to stop receiving certain communications, you may unsubscribe by clicking on the link provided in future emails or contacting us at privacy@tonixpharma.com.

Would you like to receive your savings card information via text message?