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Because of the risks of corporal rupture and other serious injuries to. For eligible patients, submit the xiaflex® claim form to the program via fax, email, or mail. The xiaflex® copay savings program process. I also authorize endo advantage ,. What to know when your doctor orders from. My signature below certifies (1) that the person named on this form is my patient and that xiaflex. Please send this completed form to:. Endo has worked with the fda to develop the xiaflex ® rems program. My signature below certifies (1) that the person named on this form is my patient and that xiaflex.