Get more information on RAPTIVA

Sign up for your FREE information kit about RAPTIVA today!

Receive our fact-filled information kit, which includes a DVD full of real stories from real people who have experienced, and continue to experience, the benefits that RAPTIVA has to offer. You will also receive a brochure that will tell you about RAPTIVA, as well as a helpful RAPTIVA discussion guide. This guide will help you talk about RAPTIVA to a dermatologist to see if it's right for you, so bring it when you go.

Request your FREE kit today to learn how RAPTIVA may be able to give you clearer skin.

Fill out the form and answer the questions below.

Please tell us how you feel about your psoriasis:

• I would consider my psoriasis:
• Mild
• Moderate
• Severe

Since I was first diagnosed with psoriasis, it has:
• Improved
• Not changed
• Worsened

My psoriasis makes me feel:
• Physically uncomfortable (itching, bleeding, pain)
• Self-conscious in social situations
• Both
• Neither

I would consider injecting myself once a week if the medicine made an improvement in my psoriasis:
• Strongly agree
• Somewhat agree
• Somewhat disagree
• Strongly disagree

Are you satisfied or dissatisfied with your current treatment regimen for psoriasis?
• Satisfied
• Dissatisfied

When is your next scheduled dermatologist appointment?
• Within 30 days
• 30-60 days
• Over 60 days

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