Complete the form below to keep up-to-date on the latest information about TRELEGY as it becomes available.

Please enter your information below.

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* Has your doctor prescribed TRELEGY?

* Have you started taking TRELEGY?

Program Enrollment:

GlaxoSmithKline (GSK) believes your privacy is important. By providing your name, address, email address, and other information, you are giving GSK and companies working with GSK permission to market or advertise to you across multiple channels, eg, mail, email, websites, online advertising, applications, and services, regarding the medical condition(s) in which you have expressed an interest, as well as other health-related information from GSK. GSK will not sell or transfer your name, address, or email address to any other party for their own marketing use.

For additional information regarding how GSK handles your information, please see our privacy statement.

Savings Offer Consent:

I'd like to receive savings offers on my prescription. I understand by selecting "I agree" below, that I am agreeing GSK and companies working with GSK (for example, the program administrator) can use the personal information I provide when I enroll, as well as information received from my pharmacy about my use of the savings offer and the date on which I filled my prescription. GSK and the program administrator have my consent to use the information to select additional mailings and offers that may be of interest to me in connection with this program. I understand that I can revoke this authorization at any time by contacting GSK at 1-888-825-5249 or, and that even if I decide not to participate in this GSK offer, it will not impact my ability to receive treatment from my healthcare provider.

In order to join this program and be eligible for the savings offer, you must agree to the savings offer consent above. If you would like to change your answer, please select "I agree to the savings offer consent."

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit, or call 1-800-FDA-1088.

TRELEGY ELLIPTA was developed in collaboration with INNOVIVA

Trademarks are owned by or licensed to the GSK group of companies.