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Thank you for doing something to help your loved one by learning more about Alzheimer's.
To get the guide to Alzheimer's, please take a few moments to fill out the form below.
Required fields are in bold.
Who are you requesting information for?
 Your loved one    Yourself

Please provide the following information about yourself:
First Name
Last Name
Address Line 1
Address Line 2
City
State
Zip code
Date of Birth
   
Email Address
Please provide the following information about your loved one:
(Please note, information will only be sent to you, not to your loved one.)
First Name
Last Name
Address Line 1
Address Line 2
City
State
Zip code
Date of Birth
   

Please choose one of the options below:
I would like to receive Alzheimer's disease information and learn about a prescription treatment option.
I would like to receive Alzheimer's disease information only.
Is your loved one:
Not diagnosed with Alzheimer's
Diagnosed with Alzheimer's

Would you like to receive the ARICEPT welcome kit?
Yes
No

Please choose one of the options below:
Eisai/Pfizer may use the information I provided to send me the materials I have requested.
In addition to the materials I have requested, Eisai/Pfizer may contact me from time to time about special offers and updates on Alzheimer's, a prescription treatment option, and related health issues.
In addition to the materials I have requested, Eisai/Pfizer and companies working with Eisai/Pfizer may use the information I provided to help develop Eisai/Pfizer products, services, and programs, provide me with materials I may find useful, and contact me about health-related topics.

Privacy Statement

Eisai Inc. and Pfizer Inc respect your right to have personal and medical information kept confidential. Eisai Inc. and Pfizer Inc and companies working with them will use the information you provide to give you personally relevant information about Alzheimer's disease and a prescription treatment option and to develop new products, services, and programs you may find useful. It will not be shared with any third parties (such as outside mailing lists).
  This Web site contains information relating to various medical conditions and treatment. Such information is provided for educational purposes only and is not meant to be a substitute for the advice of a physician or other health care professional. You should not use this information for diagnosing a health problem or disease. In order for you to make intelligent health care decisions, you should always consult with a physician or other health care provider for you, or your loved one's, personal medical needs.

All quotes included in this Web site represent the individual experience of some doctors, some patients, and their caregivers. Individual responses to treatment may vary. Actual identities have been changed to protect individual privacy.

This site is intended for residents of the United States only. The products discussed herein may have different product labeling in different countries.
©2008 Eisai Inc. and Pfizer Inc. All rights reserved. ARU00248F
 
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