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.

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Physician Type

I understand that Bayer Inc. (''Bayer'') and its affiliates, and Health Loyalty^® as program administrator on behalf of Bayer, obtain my personal information on this form for purposes of administering the Bayer EYLEA^® HD Replacement Program, including monitoring and optimizing these and other Bayer programs and for program research and evaluation. I also understand that Bayer is required to report adverse drug events to regulators and that my information may be disclosed for this purpose. I understand that my information may be transferred outside of my province and/or Canada and accessible to law enforcement or other authorities. Information on Bayer’s privacy practices including privacy rights may be accessed at: https://www.bayer.ca/en/privacy-statement/. I am a licensed Canadian Healthcare Professional authorized to prescribe EYLEA^® and/or EYLEA^® HD. 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 Bayer EYLEA^® HD 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^® HD 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^® HD Replacement Program

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