Patient Package Insert | Español Safety Information Send Me More Information Q & A Birth control is an important decision. The more you know about ParaGard®, the better you can talk with your healthcare professional about your options. To help us make sure we're sending you the information that will best assist you, please answer the following questions: I certify that I am 18 years or older Get Info If you have ParaGard®... Register So that we send you information and news that's most relevant to you, we need to know a little about you. Your personal information will not be shared with outside parties. Please complete the form and click SUBMIT *represents a required field How would you like us to contact you? How did you hear about ParaGard®? -Choose-Email Regular mail -Choose-Mail Ad in Magazine Internet Advertising Email Friend Search Engine Healthcare Provider Article in Magazine Newspaper Television Radio * First Name: * Last Name: * Email Address: Phone Number: * Street Address: Address2: * City: * State: -Choose-AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXTXUTVAVTWAWIWVWY * ZIP Code: What is your current or most recent method of birth control? (Please Choose One) Birth Control Pills Condoms Intrauterine Contraceptive (IUC) Patch Shot Diaphragm Ring Natural Family Planning/Rhythm Method/Fertility Awareness Never Used Any Method Other ParaGard® has many benefits; we'd love to know what's most important to you personally. Please rank the following in order of importance. (1=Very Important, 5=Not Important) 1 2 3 4 5 1. Highly effective - more than 99% 2. Totally hormone free 3. Virtually hassle free with no daily or weekly routine - just a simple monthly self check 4. Flexible - you choose how long to use it, for 1 up to 10 years 5. Rapid return to fertility - no waiting to try to get pregnant 6. Offers immediate pregnancy protection after insertion 7. No monthly refills 8. Cost effective when used for 2 years or more What is your relationship status? Single Engaged Married Divorced What are your plans for a family? Am planning on having children in the future Am planning on having more children Am finished having children Have no plans for children Undecided I understand that by completing this registration form, I am providing information that may be deemed personally identifiable information. I authorize Duramed Pharmaceuticals, Inc. to disclose my personally identifiable information to its affiliated companies and contractors, including Barr Laboratories, Inc. (collectively "Affiliates and Contractors"), on a need-to-know basis for purposes of administering both programs related to ParaGard® and other programs administered by Duramed Pharmaceuticals, Inc. I understand that Duramed and its Affiliates and Contractors value my privacy. As such, Duramed and its Affiliates and Contractors will take responsible and appropriate measures to protect the information provided on this form from inappropriate disclosure. However, I also understand that this authorization permits Duramed and its Affiliates and Contractors to share my personally identifiable information with other individuals/entities that may not be bound ethically or by any privacy laws and that, once in their possession, my information could be used or redisclosed for any purpose. I understand that I may revoke this authorization, in writing, at any time by sending a written notice of revocation to Duramed, Attn: ParaGard® Product Manager, 223 Quaker Road, Pomona, NY 10970. I understand that only a written revocation addressed to such person will constitute an effective withdrawal of my authorization, and that any such revocation will not be effective with respect to disclosures made by Duramed or its Affiliates or Contractors prior to receipt of the revocation by Duramed. If you decide that you no longer wish to receive informational mailings from this Web site, click here to be removed from our contact list. So that we send you information and news that's most relevant to you, we need to know a little about you. Your personal information will not be shared with outside parties. Please complete the form and click SUBMIT *represents a required field How would you like us to contact you? How did you hear about ParaGard®? -Choose-Email Regular mail -Choose-Mail Ad in Magazine Internet Advertising Email Friend Search Engine Healthcare Provider Article in Magazine Newspaper Television Radio * First Name: * Last Name: * Email Address: Phone Number: Street Address: Address2: City: State: -Choose-AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXTXUTVAVTWAWIWVWY ZIP Code: What is your current or most recent method of birth control? (Please Choose One) Birth Control Pills Condoms Intrauterine Contraceptive (IUC) Patch Shot Diaphragm Ring Natural Family Planning/Rhythm Method/Fertility Awareness Never Used Any Method Other ParaGard® has many benefits; we'd love to know what's most important to you personally. Please rank the following in order of importance. (1=Very Important, 5=Not Important) 1 2 3 4 5 1. Highly effective - more than 99% 2. Totally hormone free 3. Virtually hassle free with no daily or weekly routine - just a simple monthly self check 4. Flexible - you choose how long to use it, for 1 up to 10 years 5. Rapid return to fertility - no waiting to try to get pregnant 6. Offers immediate pregnancy protection after insertion 7. No monthly refills 8. Cost effective when used for 2 years or more What is your relationship status? Single Engaged Married Divorced What are your plans for a family? Am planning on having children in the future Am planning on having more children Am finished having children Have no plans for children Undecided I understand that by completing this registration form, I am providing information that may be deemed personally identifiable information. I authorize Duramed Pharmaceuticals, Inc. to disclose my personally identifiable information to its affiliated companies and contractors, including Barr Laboratories, Inc. (collectively "Affiliates and Contractors"), on a need-to-know basis for purposes of administering both programs related to ParaGard® and other programs administered by Duramed Pharmaceuticals, Inc. I understand that Duramed and its Affiliates and Contractors value my privacy. As such, Duramed and its Affiliates and Contractors will take responsible and appropriate measures to protect the information provided on this form from inappropriate disclosure. However, I also understand that this authorization permits Duramed and its Affiliates and Contractors to share my personally identifiable information with other individuals/entities that may not be bound ethically or by any privacy laws and that, once in their possession, my information could be used or redisclosed for any purpose. I understand that I may revoke this authorization, in writing, at any time by sending a written notice of revocation to Duramed, Attn: ParaGard® Product Manager, 223 Quaker Road, Pomona, NY 10970. I understand that only a written revocation addressed to such person will constitute an effective withdrawal of my authorization, and that any such revocation will not be effective with respect to disclosures made by Duramed or its Affiliates or Contractors prior to receipt of the revocation by Duramed. If you decide that you no longer wish to receive informational mailings from this Web site, click here to be removed from our contact list. ParaGard® Important Safety Information Click here to view the ParaGard® Safety Information ParaGard® does not protect against HIV or STDs. You may have heavier or longer periods or spotting between periods, which usually subsides after 2-3 months. Complications may occur from placement. You must not use ParaGard® if you have pelvic inflammatory disease (PID) or engage in behavior putting you at high risk for PID, have a history of certain reproductive cancers or infections, have Wilson's disease, or might be pregnant. Nothing on this Website should be construed as the giving of advice or the making of a recommendation, and it should not be relied on as the basis for any decision or action. It is important that you rely only on the advice of a healthcare professional to advise you on your specific situation. Click to download Patient Package Insert and Prescribing Information Home | About Us | Contact Us| Site Map | Legal | Español ®2007 Duramed Pharmaceuticals, Inc. All rights reserved. ParaGard® is a registered trademark and "Birth Control That Fits Your Life.TM" is a trademark of Duramed Pharmaceuticals, Inc. Duramed is a subsidiary of Barr Pharmaceuticals, Inc. This site is intended for residents of the United States only. Powered by -