To receive your FREE water bottle, please complete this short survey.

Survey must be submitted by December 20, 2008 to receive your FREE gift.

Required Information*

First Name*
Last Name*
Address*
City*
State*
Zip Code*
Date Of Birth* / /   (e.g. MM/DD/YYYY)
Email*
Phone - -    (e.g. 999-999-9999)

1. When did you start taking FLOMAX?
/ / (Approximate MM/DD/YYYY)

2. What motivated you to start taking FLOMAX? (Check the one that most applies.)
I was tired of waking up in the middle of the night to go to the bathroom
I was frustrated with planning my life around my male urinary symptoms
Discussed with a family member or friend
Advice from my doctor

3. Are you taking FLOMAX every day?
 Yes   No

4. Did you receive a refill prescription from your doctor?
 Yes   No

    If so, do you intend to refill your next prescription?
 Yes   No

 

Important Safety Information
FLOMAX is approved to treat male urinary symptoms due to BPH, also called an enlarged prostate. Only your doctor can tell if you have BPH, not a more serious condition like prostate cancer. Avoid driving or hazardous tasks for 12 hours after your first dose or increase in dose, as a sudden drop in blood pressure may occur, rarely resulting in fainting. If considering cataract surgery, tell your eye surgeon you’ve taken FLOMAX. Common side effects are runny nose, dizziness and decrease in semen.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Before taking FLOMAX capsules, please see the full Prescribing Information and Patient Information.

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