I certify that I am a Healthcare Professional
By checking this box, I represent that I am disclosing this information to Allergan, its affiliates, agents, representatives, and service providers (together “ALLERGAN”) to help enable treatment for this patient. I further certify that the patient is aware of, has consented to, and has directed my disclosure of their information to ALLERGAN to enable services to the patient for such purposes, including to perform insurance coverage verification and insurance reimbursement services, and that such consent and direction applies to disclosures made through the duration of the patient’s therapy. Any personal data you provide us will be processed according to our Privacy Notices which can be found below or by clicking on