Thank you for your interest in our free refill reminder service. It’s a great way to keep track of your FLOMAX prescription to help keep your BPH symptoms under control. We’ll send you an email reminder every 30 or 90 days, depending upon your prescription refill requirements.

The service will be available early in 2007. Please provide us with your name and email address so that we may notify you when it is ready.

Required Information*

First Name*
Last Name*
Email Address*

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).

You are about to submit the following information. Please click “SUBMIT” to verify that all answers are correct. If you need to make changes, click “Clear Form” to do so.

Important Safety Information
FLOMAX is approved to treat male urinary symptoms due to BPH. Only your doctor can tell if your symptoms are due to BPH and not another condition such as prostate cancer. Common side effects of FLOMAX are runny nose, dizziness and decrease in semen. A sudden decrease in blood pressure may occur upon standing, rarely resulting in fainting. So when starting FLOMAX, avoid situations where injury could result. If considering cataract surgery, tell your eye surgeon you have taken FLOMAX capsules.

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

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