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Request a rebate by providing the information below.
Print your rebate coupon after completing the form below. Only 1 rebate per customer. See additional terms and conditions below – coupon valid for commercial and cash-pay patients only.
Offer not valid for prescriptions purchased under Medicare, Medicaid, certain similar federal or state programs, or where prohibited by law. Under certain state laws, you may need to disclose your acceptance of offers to your third-party payer (insurer). This rebate coupon must be accompanied by proof of purchase (pharmacy receipt), may not be reproduced, and must accompany this request. Proof of purchase will not be returned. Eligibility is restricted to individuals: no clubs, groups, or organizations. Offer good only in the USA. Void where taxed or restricted.
If you have already registered, but would like to print your rebate again, please click here.
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