To request a ServierONE Patient Starter Kit,
please fill out the following information.

To request a ServierONE Patient Starter Kit, please fill out the following information.

* Patient Treatment

* First Name

* Last Name

* Shipping Address

* City

* State

* Zip

* Email

* Required Fields

By checking this box, I agree to provide my consent for Servier and their associates to collect and use my personal information for the sole purpose of shipping the Patient Starter Kit. I acknowledge that my information will be handled in accordance with Servier’s Privacy Policy.

* Each person is permitted to receive only one Patient Starter Kit.

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Servier and the Servier Logo are registered trademarks of LES LABORATOIRES SERVIER.
US-PAT-00079 02/25

ServierONE Patient Support Program

Patient Starter Kit Ordering Portal

To request a ServierONE Patient Starter Kit,
please fill out the following information.

To request a ServierONE Patient Starter Kit, please fill out the following information.