Savings and Support Registration [1] By providing consent, you agree to the collection and use of your Sensitive Personal Information (SPI). Examples of SPI may include, but are not limited to health related information. We use this information consistent with our Privacy Policy [2], including to personalize the information you receive, fulfill any requests you submit, and to research, develop, and improve our products and services. By checking the box, you indicate that you read, understand, and agree to such collection and use of your SPI. US_SENSITIVE_PI * *Have you been prescribed XARELTO®? * Yes No *Choose your health condition: * Nonvalvular Atrial Fibrillation (AFib) Deep Vein Thrombosis (DVT) Pulmonary Embolism (PE) Knee or Hip Replacement Surgery Coronary Artery Disease (CAD) Peripheral Artery Disease (PAD) Non-Surgical Hospitalization Were you prescribed XARELTO® 10 mg because you have recently undergone hip or knee replacement surgery? * Yes, I have been prescribed XARELTO® 10 mg because I have recently undergone hip or knee replacement surgery No, I have not been prescribed XARELTO® 10 mg because I have recently undergone hip or knee replacement surgery Were you prescribed XARELTO® 10 mg after a recent non-surgical hospitalization? * Yes, I have been prescribed XARELTO® 10 mg due to a recent non-surgical hospitalization No, I have not been prescribed XARELTO® 10 mg due to a recent non-surgical hospitalization *I want to register for: * The Janssen CarePath Savings Program for XARELTO® is not available to patients only taking XARELTO® after a recent non-surgical hospitalization or a knee or hip replacement surgery. Thank you for your interest in our Savings and Support offerings. Unfortunately, these resources are not currently available to patients taking XARELTO® after a recent non-surgical hospitalization. However, we can provide information on other resources that may help you save on XARELTO®. Visit JanssenCarePath.com [3] to learn more. Ongoing Educational Support for XARELTO®Get communications to help you better understand your condition and how XARELTO® can help you set and keep your health goals. Janssen CarePath Savings Program for XARELTO®By signing up, eligible patients using commercial or private insurance can save on out-of-pocket costs for XARELTO®. Personalized Refill Reminders for XARELTO®I would like to receive personalized refill reminders based on my needs. Reminder-optin Account information *First Name * *Last Name * I am a caregiver I am a caregiver *Sex * Male Female *Date of Birth * *Address Line 1 * Address Line 2 *City * *State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming *ZIP Code * *Email * *Confirm Email * *Password * *Confirm Password * *Phone Number * iBy providing your phone number, we will be able to contact you with useful information about XARELTO®. *Phone Type * Home Mobile Office I would like to receive text messages relating to my registrations selected above.Message and data rates may apply. Message frequency varies. I understand I am not required to provide my permission to receive text messages to participate in the Janssen CarePath Savings Program or to receive any other communications I have selected. Refill reminder text opt-in I would like to receive text messages relating to the Savings Program.Message and data rates may apply. Message frequency varies. I understand I am not required to provide my permission to receive text messages to participate in the Janssen CarePath Savings Program or to receive any other communications I have selected. Text message from the program based on registration If I’m unavailable, please leave a message, including the prescription name XARELTO®. Leave Message I would like to receive communications by US mail. Would you like to receive communications by US mail? Health information *How long have you been taking XARELTO®? * I’m just starting I’ve been taking XARELTO® for at least 4 months *How long have you been taking XARELTO®? * I’m just starting I’ve been taking XARELTO® for at least 3 months *How long have you been taking XARELTO®? * I’m just starting I’ve been taking XARELTO® for at least 3 months *What medications are you currently taking for AFib? * Aspirin Warfarin (Coumadin®, Jantoven®) or other blood thinner Rate or rhythm control medications I am not currently taking medication for my AFib When is your next doctor’s appointment? *Have you had a heart attack, a stent put in, or bypass surgery? * Yes No *How long has it been since your event? * - Select -Less than 1 year ago1-4 years agoOver 4 years ago *What medications are you currently taking for CAD? * Aspirin plus one other antiplatelet medicine such as Clopidogrel (Plavix®), Prasugrel (Effient®), or Ticagrelor (Brilinta®) Aspirin alone An antiplatelet medicine such as Clopidogrel (Plavix®), Prasugrel (Effient®), or Ticagrelor (Brilinta®) I’m not sure Other medication *What medications are you currently taking for DVT? * Warfarin (Coumadin®, Jantoven®) or other blood thinner I am not currently taking medication for DVT, but I’ve had a DVT in the past When is your next doctor’s appointment? *Did you complete treatment within the last 3 months? * Yes No *Have you had a blocked artery that led to pain in your limb (i.e., arm, leg, lower torso)? * Yes No *How long has it been since your event? * - Select -Less than 1 year ago1-4 years agoOver 4 years ago *What medications are you currently taking for PAD? * Aspirin plus one other antiplatelet medicine such as Clopidogrel (Plavix®), Prasugrel (Effient®), or Ticagrelor (Brilinta®) Aspirin alone An antiplatelet medicine such as Clopidogrel (Plavix®), Prasugrel (Effient®), or Ticagrelor (Brilinta®) I’m not sure Other medication *What medications are you currently taking for PE? * Warfarin (Coumadin®, Jantoven®) or other blood thinner I am not currently taking medication for PE, but I’ve had a PE in the past When is your next doctor’s appointment? *Did you complete treatment within the last 3 months? * Yes No *Did your doctor give you a Janssen CarePath Savings Program card for XARELTO®? * Yes, I have a Janssen CarePath Savings Program card for XARELTO® and I need to register it. No, I want to get a Janssen CarePath Savings Program card for XARELTO®. *Member ID on card * *Would you like to receive Ongoing Educational Support for XARELTO®? * Yes, I would like communications to better understand my condition and how XARELTO® can help, plus tools like refill and medication reminders. No, I prefer not to receive educational information about my condition and XARELTO®. *I am at least 18 years of age and a resident of the US or its territories. Age and a resident * Leave this field blank Submit