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

Tell us about yourself

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Note: All information is required unless otherwise indicated.

Your Birthdate
Age Range of Patient:

Patient must weigh at least 33 lb (15 kg)

Find a mentor

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

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

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Which Day(s) Work Best for Calls? (Select All That Apply):
Which Times Work Best for Calls? (Select up to 3):
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