Doctor Consent wording

I agree that by enrolling patients in the Saxenda Product Familiarisation Program or Patient Support Program my prescribing information may be recorded by a commissioned third party to better manage the programs, facilitate additional services, and process samples requests as required. No identifiable patient data will be provided to Novo Nordisk. Aggregated and de-identified patient data may be offered for analysis and program improvement. I understand that I may remove my enrolment at any time by emailing saxenda@pharmaprograms.com.au or 

calling 1300 079 839.


I acknowledge that information provided by patients, caregivers, or their treatment providers to a member of the Novo Nordisk SaxendaCare’s patient services team will be shared with other members of the team who are directly involved in patient assistance on a need to know basis only. Information will be shared in order to provide effective services; to assist patients with their stated needs; and to ensure appropriate and adequate treatment of patients.

I consent to the collection, use, transfer, disclosure and destruction of your personal information as set out in our Privacy Policy which is located at http://www.novonordisk.com.au. My continued use of this Site, or a service we provide to you as a result of registering on this Site, is also subject to the terms and conditions set out in our Saxenda® Website Terms of Use which can also be located at http://www.novonordisk.com.au.