Bayer Registration

Please complete the following fields to register for Health Loyalty and receive your login credentials.

Note: Some registrations require verification before credentials are delivered.

PO Boxes and Residential addresses are not accepted, a physical street address for the clinic must be provided.

If you already have received your login credentials Click here to login.

Preferred Language

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Physician Type

I consent to the collection, use and disclosure of my personal information by Bayer Inc. ("Bayer") and its affiliates for the purpose of administering the Bayer EYLEA^® Replacement Program and allowing Bayer and its affiliates to comply with reporting obligations. I understand my information will be used, stored and otherwise processed as described in Bayer's Privacy Statement located at https://www.bayer.ca/en/privacy-statement/. I understand that I may withdraw my consent at any time. I am a licensed Canadian Healthcare Professional authorized to prescribe EYLEA^®. I understand that Bayer funds this program and I will make my patient aware of this funding. I agree to be contacted by Health Loyalty^® or Bayer for the purposes of administration of the EYLEA^® Replacement Program. I certify that all information provided in this form is true and accurate. I understand and acknowledge that submission of false information may result in permanent denial or revocation of access to the Bayer EYLEA^® Replacement Program.

I consent to receive emails and other forms of electronic messages from Bayer Inc and its affiliates containing product information and updates, feedback, news, events and promotions. I may withdraw my consent at any time by contacting Bayer Inc at 2920 Matheson Blvd E, Mississauga, ON L4W 5R6. Tel: 1-800-622-2937 or by sending an e-mail to privacycanada@bayer.com.

EYLEA^® Replacement

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You will receive your log in credentials within 24-48 hours.

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