Register for the LUCENTIS Patient Support Program

This program is available to patients who have been diagnosed with wet age-related macular degeneration (wet AMD) or diabetic retinopathy (DR) with or without diabetic macular edema (DME).  Join now to take advantage of this program at no cost to you.

*Required

Who are you requesting information for?*

Yourself
Someone for whom you provide care

Are you or your loved one currently receiving LUCENTIS?*

Yes
No

Which of the following conditions have you or your loved one been diagnosed with?*

Wet age-related macular degeneration (wet AMD)
Diabetic retinopathy (DR)
Diabetic macular edema (DME)




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I verify that I am 18 years of age or older.*

By completing and submitting this form, you agree to allow Genentech and its agents to collect the information provided and to be contacted by Genentech and its agents in the future regarding Lucentis, other Genentech products, and related disease education. Genentech will not sell, rent, or otherwise distribute your name and any personally identifiable information outside of Genentech and its agents. Genentech will only use your information in accordance with its Privacy Policy.

Thank you for your responses! We will be sending you a welcome e-mail and other materials soon to help support you throughout your LUCENTIS® journey.