Sanofi is dedicated to protecting your personal privacy. The personal information entered to register for this application will only be utilized for enrollment into requested services and not shared or used for any other purposes.

Sanofi agrees to protect My Information by using and disclosing it only for the purposes of this program or as otherwise required by law. I understand that I may have certain rights under applicable data privacy laws regarding My information, including the right to access my information held by Sanofi Genzyme. For further information regarding these rights, please reference the Sanofi’s Global Privacy Policy.

This Application is an informational reference tool, and does not constitute a regulated medical device This Application does not provide medical guidance, advice, diagnoses, or treatment recommendations, and does not cure, treat, prevent, or mitigate any disease. Your healthcare professional is the best source of information regarding your health. Please consult your healthcare professional if you have any questions about your health or treatment.

Sanofi Genzyme will provide up to two (2) kits of Thyrogen® (thyrotropin alfa) per year for eligible uninsured and underinsured patients through the patient assistance program. If approved, shipment will be coordinated with the requesting physician. This is not a replacement program; applications must be submitted prior to Thyrogen use. Thyrogen received through this program shall not be resold and providers shall not bill any patient or third party payer, including Medicare and Medicaid. This program is not meant to induce a physician to use or prescribe Thyrogen. The program provides drug only; patients would need to find alternative means to support other medical costs associated with follow-up diagnostic tests and treatment, if necessary. Sanofi Genzyme reserves the right to review patient profiles, grant requests based on patient need and to change program guidelines or terminate the program at any time without notification.

I acknowledge that by checking the Text Messaging Consent box, I expressly consent to receive text messages from or on behalf of Sanofi 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 my wireless service provider’s message and data rates may apply to any text messages that I receive from or on behalf of Sanofi at the mobile telephone number(s) that I provide. I understand that I can opt out of future text messages at any time by texting STOP to 4154309359 from my mobile phone and that I can request help for text message by texting HELP to 4154309359. I also understand that additional terms and conditions regarding my receipt of text messages from or on behalf of Sanofi may be provided to me in the future as part of an opt-in confirmation text message. I understand that my consent to receiving text messages from or on behalf of Sanofi is not required as a condition of purchasing any goods or services from Sanofi or its affiliates.