Order OPENINGS® Patient Support Program Starter Kits

Order OPENINGS® Patient Support Program Starter Kits

To request kits, please fill in the fields below. Allow 2-3 weeks for delivery.

Name of Doctor

State License #

Name of Practice

Specialty: Ophthalmologist, Optometrist, Other

Address

Address

City
State
Zip

Ship to the attention of

Phone Number

E-mail Address

Confirm E-mail Address

Number of English kits*

Number of Spanish kits*
*Maximum of 20 kits total (any combination per address per month)

Privacy Statement : Alcon will use this information to respond to your request. Please read our Privacy Policy for more information.

I HAVE READ AND AGREED TO ALCON'S PRIVACY STATEMENT.

Eligibility: Offer applies only to eligible Alcon prescriptions that are subject to a commercial health plan co-pay of more than $30. This offer is not valid for patients who are enrolled in Medicare Part D, Medicaid, Medigap, VA, DOD, Tricare, or any other government-run or government-sponsored health care program with a pharmacy benefit. Click here for full terms and conditions.

 
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