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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.

First name *

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Last name *

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Birth Date *

Please enter the Date of Birth as MMDDYYYY. All other formatting will occur automatically.

Gender *

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Male

Female

Address 1 *

Address 2 *

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City *

State *

Select a State

Zip Code *

Five digits only

Email *

Help text Email

Mobile Number *

Help text Mobile number

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.

OK to leave detailed voice mail about your medication on your phone *

Drop Down Help text

Select Answer...

Type of Insurance *

Rating Help text

Medicare/MedicaidUninsuredEmpty

No rating

Consumer Status *

I am taking SCEMBLIX for an approved use, consistent with the product's Prescribing information. See below for approved uses.*

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.

Thank you for signing up for the Novartis Patient Navigator Program.

Thank you for registering. A Navigator will be contacting you to confirm your eligibility.

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