This will take about 3 minutes to complete. Tell us a little bit about yourself, and we will connect you with a mentor. 
For questions, call 1-855-776-8966 (M-F: 8 AM-5 PM CT).

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Which days of the week are you typically available to speak with your mentor? (Select all that apply.) *

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What time of day are you typically available to speak with your mentor? (Select all that apply.) *

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Tell us about the kind of person you are hoping to connect with. We will do our best to match you with a mentor who meets your preferences.

I consent to the collection, use, and disclosure of my health-related personal data and/or precise geolocation personal data to receive communications from AbbVie regarding its products, programs, services, clinical trials, research opportunities and for online targeted advertising, as further described in the “How we may use Personal Data,” “How we disclose Personal Data,” and “Cookies and similar tracking and data collection technologies” sections of our Privacy Notice. My consent is required to process sensitive personal data under certain privacy laws, and I have the right to withdraw my consent by visiting “Your Privacy Choices” on AbbVie’s website.

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AbbVie may collect your personal data through your online and offline interactions with us, including your contact data, geolocation, and health-related data...+Expand for more information.

...We may also collect your online usage data automatically through cookies and similar technologies. We use this information for several purposes, such as to provide you with, administer, and improve our programs, services and products, customize your experiences, and for research and analytics. We retain your personal data for as long as necessary to fulfill these purposes or to comply with our record retention obligations. We do not sell your personal data, but may use and disclose your personal data with marketing and advertising partners to deliver you ads based on your interests inferred from your activity across other unaffiliated sites and services (“online targeted advertising”) and for website analytics. To opt out of the use or disclosure of your personal data for online targeted advertising or for website analytics, go to Your Privacy Choices on our website. For more information on the personal data categories we collect, the purposes for their collection, disclosures to third parties, and data retention, visit our Privacy Notice

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Through my submission of the Registration Form, I consent to the collection, use, and disclosure of my personal health data, as described in the Privacy Notice above and in AbbVie’s Privacy Notice in the “How We May Disclose Personal Data” section. My consent is required to process sensitive personal data under certain privacy laws, and I have the right to withdraw my consent by visiting “Your Privacy Choices” on AbbVie’s website. 

By submitting this form, you acknowledge that you would like to enroll in the Duopa Mentor Program, which is an AbbVie patient support program that connects you with a volunteer Mentor already using Duopa therapy. Some of the enrollment information you provided will be shared with your Mentor and Duopa program staff so that they can reach out to you and provide you with the Duopa program services.

Please be aware that phone conversations with volunteer Mentors are not monitored or recorded. AbbVie is not responsible for any statements or experiences shared by Mentors. Although Mentors are instructed not to disclose your personal information to others, including any health information that you may share, AbbVie cannot guarantee that this will not happen. Please exercise caution before discussing your personal and health information with your Mentor. You authorize AbbVie to contact you by phone (including leaving a voicemail that mentions the Duopa Peer Mentor Program), email or other means of communication and use your personal information for other business purposes by AbbVie, such as to offer you the opportunity to receive notices regarding AbbVie's products or services, to invite you to participate in surveys about AbbVie products, or to notify you about special promotions.

Additionally, your Mentor will not share anything about you with your health care provider. Your participation in the Mentor Program does NOT and is not intended to replace your relationship with your health care provider, nor is it intended to provide medical advice.

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