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tecfidera Sign Up Information

Last Updated:

12/12/2019

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Yes

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Data Held

Email Address

Date of Birth

Password

Password, Confirm Password

Your Name

First Name, Last Name

Your Address

Home Address, City, State, Zipcode

Phone Number

Phone

Post-Registration Data

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Membership Emails

Below is a sample of the emails you can expect to receive when signed up to tecfidera.

Thank you for signing up with ...

Thank you for signing up with us
You have been added to our mailing list and will begin receiving information about TECFIDERA soon. As an enrolled member you will get all of the latest MS news and be connected to events in the MS community.
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Raw Data Registration Structure Registration Form Text

Registration

Please tell us a little more about yourself: *Required * Which of the following describes you best?

First name

Last name

Password

Phone

Home address

City

State

Zipcode

Password (confirm)

Please tell us a little more about yourself: *Required * Which of the following describes you best?

Person with MS

MS care partner

Please select

Year 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933

Yes

Please select

Aubagio� (teriflunomide) AVONEX� (interferon beta-1a) Betaseron� (interferon beta-1b) Copaxone� (glatiramer acetate injection) Extavia� (interferon beta-1b) Gilenya� (fingolimod) Glatopa� (glatiramer acetate injection) Lemtrada� (alemtuzumab)

Aubagio� (teriflunomide)

AVONEX� (interferon beta-1a)

Betaseron� (interferon beta-1b)

Copaxone� (glatiramer acetate injection)

Extavia� (interferon beta-1b)

Gilenya� (fingolimod)

Glatopa� (glatiramer acetate injection)

Lemtrada� (alemtuzumab)

Novantrone� (mitoxantrone)

Ocrevus� (ocrelizumab)

PLEGRIDY� (peginterferon beta-1a)

Rebif� (interferon beta-1a)

Steroid treatments

Tecfidera� (dimethyl fumarate)

TYSABRI� (natalizumab)

Other

Please select

Please select Aubagio� (teriflunomide) AVONEX� (interferon beta-1a) Betaseron� (interferon beta-1b) Copaxone� (glatiramer acetate injection) Extavia� (interferon beta-1b) Gilenya� (fingolimod) Glatopa� (glatiramer acetate injection) Lemtrada� (alemtuzumab)

Aubagio� (teriflunomide)

AVONEX� (interferon beta-1a)

Betaseron� (interferon beta-1b)

Copaxone� (glatiramer acetate injection)

Extavia� (interferon beta-1b)

Gilenya� (fingolimod)

Glatopa� (glatiramer acetate injection)

Lemtrada� (alemtuzumab)

Novantrone� (mitoxantrone)

Ocrevus� (ocrelizumab)

PLEGRIDY� (peginterferon beta-1a)

Rebif� (interferon beta-1a)

Steroid treatments

Tecfidera� (dimethyl fumarate)

TYSABRI� (natalizumab)

Other

Please select

Year 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933

Data Name	Data Type	Options
Please tell us a little more about yourself: Required Which of the following describes you best?	Text Box
First name	Text Box
Last name	Text Box
Password	Text Box
Email	Text Box
Phone	Text Box
Home address	Text Box
City	Text Box
State	Text Box
Zipcode	Text Box
Password (confirm)	Text Box
	option	Please tell us a little more about yourself: Required Which of the following describes you best?
	option	Person with MS
	option	MS care partner
	dropdown	Please select
	tel
	checklist
	dropdown	Please select
	dropdown	Please select
	option	Year 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933
	option	Yes
	dropdown	Please select
	checklist	Aubagio� (teriflunomide) AVONEX� (interferon beta-1a) Betaseron� (interferon beta-1b) Copaxone� (glatiramer acetate injection) Extavia� (interferon beta-1b) Gilenya� (fingolimod) Glatopa� (glatiramer acetate injection) Lemtrada� (alemtuzumab)
	checklist	Aubagio� (teriflunomide)
	checklist	AVONEX� (interferon beta-1a)
	checklist	Betaseron� (interferon beta-1b)
	checklist	Copaxone� (glatiramer acetate injection)
	checklist	Extavia� (interferon beta-1b)
	checklist	Gilenya� (fingolimod)
	checklist	Glatopa� (glatiramer acetate injection)
	checklist	Lemtrada� (alemtuzumab)
	checklist	Novantrone� (mitoxantrone)
	checklist	Ocrevus� (ocrelizumab)
	checklist	PLEGRIDY� (peginterferon beta-1a)
	checklist	Rebif� (interferon beta-1a)
	checklist	Steroid treatments
	checklist	Tecfidera� (dimethyl fumarate)
	checklist	TYSABRI� (natalizumab)
	checklist	Other
	dropdown	Please select
	dropdown	Please select
	dropdown	Please select
	dropdown	Please select
	dropdown	Please select
	dropdown	Please select
	dropdown	Please select
	dropdown	Please select
	checklist	Please select Aubagio� (teriflunomide) AVONEX� (interferon beta-1a) Betaseron� (interferon beta-1b) Copaxone� (glatiramer acetate injection) Extavia� (interferon beta-1b) Gilenya� (fingolimod) Glatopa� (glatiramer acetate injection) Lemtrada� (alemtuzumab)
	checklist	Aubagio� (teriflunomide)
	checklist	AVONEX� (interferon beta-1a)
	checklist	Betaseron� (interferon beta-1b)
	checklist	Copaxone� (glatiramer acetate injection)
	checklist	Extavia� (interferon beta-1b)
	checklist	Gilenya� (fingolimod)
	checklist	Glatopa� (glatiramer acetate injection)
	checklist	Lemtrada� (alemtuzumab)
	checklist	Novantrone� (mitoxantrone)
	checklist	Ocrevus� (ocrelizumab)
	checklist	PLEGRIDY� (peginterferon beta-1a)
	checklist	Rebif� (interferon beta-1a)
	checklist	Steroid treatments
	checklist	Tecfidera� (dimethyl fumarate)
	checklist	TYSABRI� (natalizumab)
	checklist	Other
	dropdown	Please select
	dropdown	Please select
	dropdown	Please select
	checklist	Year 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933