The Taltz Together support program is for use by US residents aged 18 years or older. By submitting this form, you confirm that you meet these requirements.

Taltz Together lets you choose the support that's right for you. We offer injection support, ongoing support, and a free sharps disposal container. A Companion in Care™ can answer questions you may have about your treatment, provide educational materials to help you manage your condition, track the status of your insurance coverage approval, and just lend an ear when you need it.

For more information on the program, please call a Taltz Together Companion in Care at 1-844-TALTZ-NOW (1-844-825-8966), Monday-Friday from 8 AM to 10 PM ET. 

Taltz Together Companions in Care are not medical professionals. Your doctor is your source for medical advice.

Choose the support you're interested in (select at least one option).
Please provide the information below. Fields with an * are required.

By providing my cell phone number and submitting this form, I agree to receive automated calls and texts about the Taltz Together program at this number. I understand that I am not required to provide my cell number to participate in the program, but if I do not, then I will not be able to receive certain program communications.
Consent Statement

Taltz Together is a customized support program offered by Eli Lilly and Company and its business partners (together, “Lilly”). As part of my participation, Lilly may use, disclose and/or transfer the personal information I supply to provide services related to my condition and treatment to administer the program. Those services include contacting me by email, mail or telephone to provide personalized service delivered by my Companion in Care including informational and marketing materials; responding to customer service requests and/or product questions; requesting feedback on my experience with the related products, services and programs including market research; disclosing my enrollment and use of these services to my healthcare providers and insurers; and analyzing and/or measuring program performance or future enhancements. 

To cancel your participation in the program, please contact us at 1-844-TALTZ-NOW (1-844-825-8966).

By clicking Submit I agree to the statement above and certify that I am at least eighteen (18) years of age.

Copyright Privacy Statement Terms of Use

Taltz® is a registered trademark of Eli Lilly and Company. Taltz Together and Companion in Care are trademarks of Eli Lilly and Company.

PP-IX-US-1479 09/2017 ©Lilly USA, LLC, 2016. All rights reserved.

If you need assistance with this form, please call 1-844-TALTZ-NOW (1-844-825-8966).

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