Just complete the brief questions below to join the Taking Smart Steps program.

As a member of the Taking Smart Steps program, you can look forward to:

  • Up to $20 off your prescription of AGGRENOX
  • Education about stroke and TIA (transient ischemic attack or “mini-stroke”)
  • Resources to help learn about reducing the risk of a subsequent stroke
  • Tips on diet and exercise
  • Tips on talking to and partnering with the doctor

Thank you for joining the Taking Smart Steps Program

Required Information *

 /  
  (e.g., 999-999-9999) 


Patient
Caregiver

Tell us about yourself.

Boehringer Ingelheim Pharmaceuticals, Inc. is asking the following questions in order to provide you with future information.


Female
Male


TIA (transient ischemic attack or “mini-stroke”)
Stroke


Fewer than 3 months
3 months or more


Yes
No


Fewer than 3 months
3 months or more


Aspirin
Plavix® (clopidogrel bisulfate)
Other
I am not currently taking any medications.

Plavix® is a registered trademark of Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership


Tell us about your loved one.

Boehringer Ingelheim Pharmaceuticals, Inc. is asking the following questions in order to provide you with future information.


Female
Male


TIA (transient ischemic attack or “mini-stroke”)
Stroke


Fewer than 3 months
3 months or more


Yes
No


Fewer than 3 months
3 months or more


Aspirin
Plavix® (clopidogrel bisulfate)
Other
My loved one is not currently taking any medications.

Plavix® is a registered trademark of Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership



We respect your right to have personal and medical information kept confidential. Companies working with us will use the information you provide to send you information, seek your opinions, and help develop products, services, and programs. If we provide you with coupons or vouchers for our products, the information we receive from the pharmacy regarding their use will also be used for the same purposes.

We won’t share your private information with anyone else—including mailing lists.

  Do you agree to the Privacy Statement Policy and allow us to use your information to provide you with health-related information, useful materials, and offers regarding our products?

Be sure to check the box to be enrolled in the Taking Smart Steps program. If you do not check the box, you will still receive your voucher for savings of up to $20 off your prescription of AGGRENOX.

Need Help paying for AGGRENOX? Our patient assistance program may be able to help. Boehringer Ingelheim CARES FOUNDATION
Important Safety Information http://www.fda.gov/Safety/MedWatch/ Prescribing Information


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