FORTEO Connect Services

Joining FORTEO Connect provides access to a team of professionals committed to helping you get off to a good start and supporting you every step of the way with FORTEO® (teriparatide [rDNA origin] injection). Please select one or both of the following FREE support services: 
FORTEO INFORMATION AND INJECTION TRAINING
Learn how to get off to a good start from a nurse educator and receive information on the delivery device and FORTEO-related questions.
ONGOING FORTEO SUPPORT
Get personalized support to help make FORTEO part of your routine today and through your full course of treatment (up to 24 months).

Patient Information and Consent

Required Information
If I provide my cell phone number and submit this form, I consent to receive automated calls and texts about FORTEO Connect at this number. I understand that I am not required to provide my cell phone number to participate in the program, but if I do not then I will not be able to receive program communications.

By submitting, I agree and certify that I am at least eighteen (18) years of age or that I am an individual authorized to act on behalf of the patient in accordance with state law.

Patient Consent

FORTEO Connect is a customized support program offered by Eli Lilly and Company and its associated 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 through 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 status updates on my enrollment and use of these services to my healthcare providers and insurers; and analyzing and/or measuring program performance or future enhancements. You have the opportunity to receive text messages. By accepting these terms, you understand that the information provided may be matched with your prescription data for purposes of evaluating future improvements to this program. You may be removed from our contact list at any time by writing to Lilly at the following address: FORTEO Connect, PO Box 4668, Trenton, NJ 08650-9108, or by calling 1-866-4-FORTEO (1-866-436-7836).



PP-TE-US-0920 02/2018. ©Lilly USA, LLC 2018. All rights reserved. 

FORTEO is a registered trademark of Eli Lilly and Company.

Need help with this form? Call FORTEO Connect at  

                           1-866-4-FORTEO (1-866-436-7836)            Lilly Logo