Sign up now for up to $20 off your first prescription.

Please fill out the form below to sign up for the Matter of FACT™ basics and get your coupon for up to $20 off your first prescription.

Required Information *

First Name *
Last Name *
Address *
City *
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ZIP Code *
Date Of Birth *
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(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
  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, as well as the information obtained about you from the pharmacy, to fulfill your request, and to help develop products, services, and programs. It will not be shared with any other third parties (such as mailing lists).

If you do not check either box below, you will receive just a one-time communication with FLOMAX information along with one coupon for up to $20 off. In order to receive additional FLOMAX offers and communications, please check either box below.

By checking here and clicking "Sign Up" below, you indicate that you agree to the above and 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 indicate that you agree to the above and allow us to use your information to advertise BPH-related and other products to you. Boehringer Ingelheim may also provide you with useful materials and contact you about health-related topics.

Click "Sign Up" to verify that all answers are correct. Click 'Clear Form' if you need to make changes.

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. When taking FLOMAX, avoid driving or hazardous tasks until you know how FLOMAX will affect you, especially after your first dose or change in dose, as a sudden drop in blood pressure may occur, rarely resulting in fainting. Tell your doctor about all medications you take. 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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