Skip to main content

Enroll in the Novartis Patient Navigator Program

To sign up for SCEMBLIX Patient Navigator, please fill out the form below, and then click "Submit" when you're finished. You must be 18 years of age or older to participate in this program.

All fields marked with a * are required.
Do you want to receive notifications? TEST *
Select a State
Five digits only
Telephone Consumer Protection Act (TCPA) Consent: I consent to receive marketing calls and texts from and on behalf of Novartis Pharmaceuticals Corporation, made with an auto dialer or prerecorded voice, at the phone number(s) provided. I understand that my consent is not required or a condition of purchase. I agree to the TCPA Terms & Conditions . Number of messages will vary based on your program selections. Message and data rates may apply. Text STOP to opt out and HELP for help.
Drop Down Help text
Select Answer...
Rating Help text
No rating

By clicking submit, I confirm I’d like to enroll in the Patient Navigator Program, and agree to receive recurring phone calls from a Novartis Patient Navigator at the number(s) provided. Calls may be prerecorded or autodialed. Consent and participation in the Program is not a condition of purchase of a product or service.

Accordion Free form

Accordion


Accordion Free form

 

FC FreeForm

Summary freeform 

Tilte for freeform


Body freeform Test 

image1

test

  1. number

Display 22/02/05

text101

Primary title


  1. Primary body

Display