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I authorize Regeneron Pharmaceuticals, Inc., the maker of EYLEA® (aflibercept) Injection, together with its collaborators, affiliates, representatives, agents, and contractors (collectively, "Regeneron"), to provide me with educational and promotional information, materials, and services. Regeneron may de-identify any health information I provide and use it in performing research, education, business analytics, marketing studies, or for other commercial purposes. Additionally, I understand that Regeneron may use my information (1) to help improve, develop, and evaluate products, services, materials, and programs related to my condition and treatment; and (2) as otherwise described in the Regeneron Privacy Policy.

I also agree that Regeneron may contact me by mail or e-mail with information about EYLEA, including its FDA-approved indications, diseases, treatments and any related information, which may contain personal information. Message and data rates may apply. I understand that I may opt out of these communications by e-mailing commercialanalytics@regeneron.com or by sending a letter to Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY 10591, Attention: Commercial Analytics.

By clicking "I accept" below, I am signing this form, indicating that I am at least 18 years old, and confirming that I have read, understand, and agree with the Regeneron Privacy Policy and Terms and Conditions.

By checking this box and clicking "I accept" below, I further authorize Regeneron to contact me by phone or SMS/text message at the telephone number I have provided, which could result in messaging or data charges to me depending on my wireless service plan. I agree to notify Regeneron if my number changes in the future. I also authorize Regeneron to contact me using prerecorded/artificial voice messages or an automatic dialing system. I understand that these calls or messages may advertise or market Regeneron's products, goods, or services. I do not need to agree to receive calls or SMS/text messages as a condition of purchasing any goods or services.
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Important Safety Information
  • EYLEA® (aflibercept) Injection is a prescription medication administered by injection into the eye. You should not use EYLEA if you have an infection in or around the eye, eye pain or redness, or known allergies to any of the ingredients in EYLEA, including aflibercept.
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