Enroll 7400

*In order to be eligible for the savings program, you must meet the following criteria: You must be 18 years of age or older to use this program with your Enstilar^® or Picato^® prescription. For Taclonex^® Topical Suspension prescriptions, you must be 12 years of age or older to use this program. You must be a resident of the United States or Puerto Rico. For specific eligibility and program restrictions, call 1-855-820-9627.

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Please select the brand you are activating your card for. Choose all that apply.

Enstilar^® Taclonex^® Topical Suspension Picato^®

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You understand that the personal information you supply and certain information pertaining to the use of your co-pay card, such as the date the transaction was processed and the amount of your co-pay that will be paid for by LEO Pharma Inc. under the LoyaltyScript Program for Enstilar^®, Taclonex^® Topical Suspension, or Picato^® will be shared with LEO Pharma Inc. the sponsor of the LoyaltyScript Program and will be used by LEO Pharma Inc. and third parties working on behalf of LEO Pharma Inc. to reach out to you by regular mail, email, and to call or text you at the mobile number you have provided to market its product(s), conduct market research and/or provide you with materials about products, disease education, or financial assistance. LEO Pharma Inc. may also contact you through mail, email phone, or text and may use your information to evaluate and improve their services and program(s). You understand that you may stop LEO Pharma Inc. from contacting you at any time by calling 1-855-820-9627, clicking on the "unsubscribe" link within any email or replying "STOP" to any text message you receive from LEO Pharma Inc.

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LEO is offering support to assist with any product-related questions. LEO Quality Care™ connects you to helpful patient support specialists who can assist you during treatment. As part of the Quality Care™ program, LEO may use your personal information to contact you via phone, e-mail, by text or mail.
You will have the option to speak with a patient support specialist after activating your card. Do you agree to the LEO Copay Savings Card Program Terms and Conditions and consent to use and disclosure of your Personal Information under the LEO Privacy Policy for the purpose of enrolling in the LEO Quality Care program?

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Welcome to the LEO Copay Savings Card Activation Site. In order to get your Copay Card, you must meet the eligibility requirements.*

LEO, the LEO Lion Design, Taclonex and Enstilar, are registered trademarks of LEO Pharma A/S. Picato is a registered trademark of LEO Laboratories Limited. © 2017 LEO Pharma Inc. All rights reserved. January 2017 MAT-06842
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Welcome to the LEO Copay Savings Card Activation Site. In order to get your Copay Card, you must meet the eligibility requirements.*

LEO, the LEO Lion Design, Taclonex and Enstilar, are registered trademarks of LEO Pharma A/S. Picato is a registered trademark of LEO Laboratories Limited. © 2017 LEO Pharma Inc. All rights reserved. January 2017 MAT-06842 Unsubscribe

LEO, the LEO Lion Design, Taclonex and Enstilar, are registered trademarks of LEO Pharma A/S. Picato is a registered trademark of LEO Laboratories Limited. © 2017 LEO Pharma Inc. All rights reserved. January 2017 MAT-06842
Unsubscribe