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 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 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