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1. Are you:
2. In the past 12 months, have you visited a rheumatologist to treat your RA?
3. Denotes a required field*
First Name*
Last Name*
Address*
Apt/Suite
City*
State*
Zip Code*

E-mail Address*
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4. Are you currently taking or have you ever taken any of the following prescription medications to treat your RA?*
 
I am taking
I have taken
DMARDs or methotrexate
Injectable biologic - for example:
Humira® (adalimumab) or Enbrel® (etanercept)
Infusion biologic - for example:
Orencia® (abatacept) or Remicade® (infliximab)
Not on treatment currently
None of the above
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5. How satisfied are you with your current RA medication in terms of how well the medicine is helping you manage your RA?*
6. In the next 3 months, how likely are you to ask your physician about a new RA treatment?
I am at least 18 years of age and I have read and accept the terms and conditions of this offer. Further, by providing this information I am giving UCB and its business partners permission to send me information regarding my disease as well as information on other related treatments, products, and services, and for marketing and informational purposes. I understand that UCB and its business partners will not sell my name, address, e-mail address, or any other information to another party for their own marketing use. I may remove myself from the mailing list at any time here: www.reachbeyondra.com/unsubscribe. Review the privacy policy here: www.reachbeyondra.com/privacypolicy.