Eligard Patient Experience Program (EliPEP)

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Welcome! Please select the option that best describes why you are here:

Choose one of the following answers

I have recently prescribed Eligard to a patient
I have recently administered Eligard to a patient
I am the caregiver of a loved one who was recently prescribed Eligard, but they have not received the injection yet
I am the caregiver of a loved one who received an Eligard injection recently

Please complete the EliPEP Prescriber Survey

Please click to complete the EliPEP Injector Survey

Please click to complete the EliPEP Caregiver Survey

This Caregiver Survey is intended to be completed after your loved one receives their Eligard injection. If your loved one has not yet received their injection, we can send you an email to remind you once the injection has been given.

Would you like to receive email reminders to complete the post-injection survey?

Choose one of the following answers

Enter the date Eligard will be administered here, if you know it. Otherwise, leave this question blank.

Please provide an email address to which we can send the survey link. If you did not provide a date in the previous question, we will send you weekly reminders until the survey is completed. Remember that the survey must be completed after your loved one has been administered Eligard.

After Eligard has been administered, please remember to come back and complete the survey.

Please confirm you want to clear your response?