Join Our Caregiver Support Program

Mild to moderate Alzheimer's disease can affect more than just the sufferer. Our Caregiver Support Program is created specifically for the dutiful caregiver by offering tips, resources, and the ability to connect with fellow caregivers.
Join today to get the support you need.
The personal information you supply to us will be shared with and among our business partners and affiliates to provide you with products, programs and services regarding Exelon Patch and related disease information and to conduct market research. Your information will not be used by any of our business partners or vendors for their own separate marketing purposes. Your information may be combined with additional information from this or other programs in which you participate, such as prescription rebate information when you redeem cards or vouchers. You have the right to cancel your participation at any time by calling 1-888-669-6682. For further information about Novartis privacy practices, please review our privacy policy.
By providing my information and clicking "Submit/I accept," I agree to receive requested materials, marketing information from Exelon Patch as well as other related health issues. I permit Novartis Pharmaceuticals Corporation to use my personal information as described in the notice listed above and as specified in our privacy policy.

 

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Please complete the following information about yourself:
* Required field.
* First Name
* Last Name
* Address
* City
* State * ZIP Code
* Email
  Please do not supply us with a wireless email address.
  Phone
In order to receive materials from the Exelon Patch you must be 18 years of age. Please confirm by providing your date of birth.
* Date of Birth
   
Are you visiting because of a concern about Alzheimer's disease or Parkinson's disease dementia?
PDD AD
Are you inquiring about Alzheimer's disease for yourself or for someone you care for?
Self Someone Else
Are you a professional caregiver (for example, a nurse, home health aide, or social worker)?
Yes No
Has the person you are inquiring for been diagnosed with Alzheimer's disease?
Yes No
Does the person you are inquiring for have a prescription for the Exelon Patch (even if they have never filled it)?
Yes No
How many Exelon Patch prescriptions have you filled for this patient?
None One or more
Is the person you are inquiring for living at home, living with you, or living in a professional facility?
Living at Home Living with You Professional Facility
If "Living at Home" is selected, pick the topic that most interests you below. We will follow up with customized emails for all
topics, starting with the one you have selected:
Dealing with Professional Caregivers Driving and Independence When You Cant Be There
If Living with You is selected, pick the topic that most interests you below. We will follow up with customized emails for all topics,
starting with the one you have selected:
Routine Activities Mind Exercises Care Facilities and Resources
.
If "Professional Facility" is selected, pick the topic that most interests you below. We will follow up with customized emails for all
topics, starting with the one you have selected:
Financial and Legal Issues Working with Professional Caregivers Ways to Communicate
We have information and rewards that might change depending on the type of prescription coverage your loved one has.
We can provide the most appropriate communications if you check the type of coverage they have below.
Government Coverage (Medicaid/Medicare Part D) Other Prescription Coverage None
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Important Safety Information