SIGN UP TO SPEAK WITH A MENTOR

Fill out this short form to connect with one of our DUPIXENT MyWay® Mentors.

Tell us about yourself

We just need you to answer a few questions to verify your eligibility and contact information.

Note: All information is required unless otherwise indicated.

Your Birthdate
Age Range of Patient:

Find a mentor

Fill out the questions below to help us find the best Mentor for you.

Note: All information is required unless otherwise indicated.

Do you have a DUPIXENT prescription?
Discussion Topics (Choose All That Apply):
Language Preference:

Communication Preferences

Fill out the questions below to set up the best time to meet with a Mentor.

Note: All information is required unless otherwise indicated.

Which Day(s) Work Best for Calls? (Select All That Apply):
Which Times Work Best for Calls? (Select up to 3):
Select Your Time Zone
Select
How Did You Hear About the Program?
Select
Additional Communication Preferences:

I acknowledge that by checking the Text Messaging Consent box, I expressly consent to receive text messages from or on behalf of the Program at the mobile telephone number(s) that I provide. I confirm that I am the subscriber for the mobile telephone number(s) provided, and I agree to notify Sanofi promptly if any of my number(s) change in the future. I understand that I can opt out from future text messages at any time by texting STOP to 94742 from my mobile phone, and that I can get help for text messages by texting HELP to 94742. I also understand that additional text messaging terms and conditions may be provided to me in the future as part of an opt-in confirmation text message. I understand that my consent is not required as a condition of purchasing any goods or services from Regeneron Pharmaceuticals, Inc. or Sanofi. Message and data rates may apply.

View Terms and Conditions and Privacy Policy.

You may have certain rights under applicable data privacy laws regarding the personal information that you provide to Sanofi, including the right to access your personal information held by Sanofi. For further information regarding these rights, please reference our Global Privacy Policy.