

Patient support for eligible and enrolled patients prescribed Dysport
Once the provider has prescribed Dysport® (abobotulinumtoxinA) for injection, the IPSEN CARES® Patient Access Specialists are fully dedicated to:
- Facilitating eligible patients’ access to their prescribed medications
- Providing information and support for the interactions among offices, patients, and insurance companies for Ipsen medications
Actual patient who has been compensated for her time.
We collect personal information to fulfill your request. Please see our Privacy Policy and our State Supplemental Privacy Policy for more information.
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Your Patient Authorization Form request has been submitted to IPSEN CARES for review. A Patient Access Specialist will review your submission and contact both you and your Healthcare Provider within 1 business day. If you have any questions or would like to learn more about IPSEN CARES and its support offerings, please call 866-435-5677, 8:00am to 8:00pm ET Monday through Friday.
IPSEN CARES PATIENT AUTHORIZATION FORM
Please be sure to review original IPSEN CARES Enrollment Form

DYSPORT is a registered trademark of Ipsen Biopharm Limited.
IPSEN CARES is a registered trademark of Ipsen S.A.
All other trademarks and registered trademarks are the property of their respective owners.
©2023 Ipsen Biopharmaceuticals, Inc. All rights reserved. January 2023 MP-US-000563