Overview and enrollment

Sign up now for one week FREE with your first prescription.

The makers of FLOMAX invite you to join the Matter of FACT™ basics, a free source for facts about male urinary symptoms due to BPH, and managing them with FLOMAX. The program was created after in-depth research with men whose lifestyles have been or could be affected by the symptoms of BPH, and its purpose is simple: to provide the facts you need to understand male urinary symptoms, and learn how to seek relief from them for yourself or someone you know.

The Matter of FACT™ basics communications include:

  • Suggestions to help you or a loved one have a productive dialogue with a doctor
  • Relevant information, offers and savings
  • Detailed information about FLOMAX
  • Prescription refill reminders

The majority of men over 60 experience BPH symptoms. You or someone you know could be one of them.

To sign up for the Matter of FACT™ basics and get your voucher for a FREE one-week trial of FLOMAX with your first prescription, please provide the following information and answer the questions below.

Required Information *

First Name *
Last Name *
Address *
City *
State *
ZIP Code *
Date Of Birth *
/ /
Email
Phone

(e.g. 999-999-9999)

Please answer the following few questions so we can start sending you pertinent information and money-saving offers.

  1. Do you suffer from male urinary symptoms associated with BPH or do you have a loved one who does?

    Sufferer Loved one
  2. What is your gender?

    Male Female
  3. Have the male urinary symptoms been diagnosed as BPH?

    Yes No
    1. If so, are you or your loved one taking one of the following treatments for male urinary symptoms? Check all that currently apply:

      Flomax®
      Avodart®
      Proscar®
      Uroxatral®
      Hytrin®
      Not currently on treatment       		terazosin
      Cardura®
      doxazosin
      Surgery
      Natural Remedies
  4. How would you like to receive future communications?

    Email Direct Mail

This information is being collected by Boehringer Ingelheim Pharmaceuticals, Inc. so that we may advertise our products to you and provide you with information about them.

Boehringer Ingelheim Pharmaceuticals, Inc. respects your right to have personal and medical information kept confidential. Boehringer Ingelheim and companies working with Boehringer Ingelheim will use the information you provide to fulfill your request. It will not be shared with any other third parties (such as mailing lists).

By checking here and clicking "Sign Up" below, you indicate that you want us to use the information you have provided to send you information and offers relating to BPH and FLOMAX from time to time.
By checking here and clicking "Sign Up" below, you also agree to allow us to use your information to advertise other products to you. Boehringer Ingelheim and companies working with Boehringer Ingelheim may use your information to help develop products, services, and programs. Boehringer Ingelheim may also provide you with useful materials and contact you about health-related topics.

If you do not check either box, we will fill just this one-time request.

You are about to submit the following information. Please click "Sign Up" to verify that all answers are correct. If you need to make changes, click 'Clear Form' to do so.

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Important Safety Information
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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