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Get more Information and
a Restroom Request Card.



Sign up to receive an educational brochure, a Restroom
Request Card and even more information about your condition.

The Restroom Request Card makes it easier to discreetly
communicate your IBD condition and request access to
restricted restrooms when unexpected symptoms arise.

Restroom Request Card

Note: Eligibility restricted to patients diagnosed with Crohn's disease or Ulcerative Colitis.


*Please select the condition you have been diagnosed with:

Previously   Currently
5-ASAs or Aminosalicylates
(Asacol HD®, Pentasa®, Lialda®, mesalamine)
Steroids (prednisone, Entocort® EC, budesonide ER)
Immune modifiers (Imuran®, azathioprine, Purinethol®, methotrexate, mercaptopurine)
Remicade® (infliximab)
Cimzia® (certolizumab pegol)
Other Biologics
Other prescription medication
None of the above
Unsure
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For US residents only.
I understand that the information I've provided will be used only by AbbVie and its contracted third parties to mail, e-mail, and phone me with helpful information on my condition and AbbVie treatments, products, and services, and for marketing and informational purposes. To be removed from our mailing list or request a copy of this information, contact: 1.888.857.0634.

Previously   Currently
5-ASAs or Aminosalicylates
(Asacol HD®, Pentasa®, Lialda®, mesalamine)
Steroids (prednisone, Uceris®, budesonide ER)
Immune modifiers (Imuran®, azathioprine, Purinethol®, mercaptopurine)
Remicade® (infliximab)
Simponi® (golimumab)
Other Biologics
Other prescription medication
None of the above
Unsure

For US residents only.
I understand that the information I've provided will be used only by AbbVie and its contracted third parties to mail, e-mail, and phone me with helpful information on my condition and AbbVie treatments, products, and services, and for marketing and informational purposes. To be removed from our mailing list or request a copy of this information, contact: 1.888.857.0634.