print_label | resize_label

Commercially insured patients can get FARXIGA for as low as $0 per month for as long as your doctor prescribes any available dose.

By completing the registration, you may also receive ongoing information and support related to your condition, including treatment information.

AstraZeneca respects your personal health information. The information you provide may be used to send you health-related materials and to develop products, services, and programs. AstraZeneca, or third parties working on our behalf, will not sell or rent personal health information. If, in the future, you no longer want to receive health-related materials, call 1-800-236-9933. Please visit www.azprivacynotice.com to review our Privacy Notice.

*Indicates required field.

Request_card

*
*
*
 
 
 
 
*
 
 Male
 Female
*

By providing your date of birth, you verify
that you are at least 18 years of age.

*
*
 Yes, I would also like to receive information in the future about all AstraZeneca products, programs, and services that may be of interest to me.
 Yes, I would be willing to be contacted on occasion to participate in market research studies sponsored by AstraZeneca.
 Yes, I would be willing to share my experience as a patient taking FARXIGA with an AstraZeneca representative.