WHEN YOU SIGN UP,
YOU'LL RECEIVE

YHIS newsletter and the RESTASIS brochure
  • A copy of the RESTASIS® Ophthalmic Emulsion Brochure: the information in this brochure can help you work with your doctor to decide if a RESTASIS® prescription is right for you.
  • A FREE subscription to Your Health in Sight®: Allergan’s quarterly newsletter, which focuses on various eye health conditions and events.

A NOTE ABOUT PRIVACY

Your answers to the survey questions, along with the answers of other individuals, may be shared in an anonymous fashion with other third parties or governmental agencies for research purposes.

Once your information has been released to Allergan, Inc., it will continue to be protected by Allergan’s privacy policy. It will not, however, have the protections of the federal privacy regulations.


Fill a RESTASIS® Ophthalmic Emulsion prescription and we’ll send you a rebate certificate for up to $20!

Register here today, and print out your rebate certificate. Then, just send it back to us with your pharmacy receipt when you fill a prescription for RESTASIS®. It’s that simple.

Read the rebate offer terms and conditions.

To receive your rebate and special offers, check the boxes below.

1. Your Information

*Required information

Allergan, Inc. will never make your e-mail address available to third parties.

2. Please tell Us About Yourself

  • Yes
  • No

  • Yes
  • No

  • More than 3 times per day
  • Daily (1-2 times per day)
  • Several times a week
  • None


[Please select all that apply.]

  • RESTASIS®
  • Artificial Tears

  • REFRESH® Brand
  • OPTIVE™ Lubricant Eye Drops
  • Visine® Pure Tears
  • Moisture Eyes
  • Tears Naturale®
  • Systane®
  • TheraTears®
  • GenTeal®
  • Other (please specify)
  • None
  • Redness Relief

  • Visine® all others
  • Clear eyes®
  • Murine®
  • Others (please specify)
  • None

  • 40 and under
  • 41-44
  • 45-49
  • 50-54
  • 55-59
  • 60 and over

3. Smart Start

4. Click to submit

REGISTRATION AND TRADEMARK INFORMATION
® and ™ marks owned by Allergan, Inc.
Clear eyes® and Murine® are registered trademarks of Prestige Brands, Inc.; GenTeal® is a registered trademark of Novartis Pharmaceuticals Corporation; Moisture Eyes is a trademark of Bausch & Lomb, Inc.; Systane® and Tears Naturale® are registered trademarks of Alcon, Inc.; TheraTears® is a registered trademark of Advanced Vision Research, Inc.; Visine® is a registered trademark of McNEIL-PPC, Inc.

RESTASIS® Ophthalmic Emulsion helps increase your eyes’ natural ability to produce tears, which may be reduced by inflammation due to Chronic Dry Eye. RESTASIS® did not increase tear production in patients using topical steroid drops or tear duct plugs.

Important Safety Information:

RESTASIS® Ophthalmic Emulsion should not be used by patients with active eye infections and has not been studied in patients with a history of herpes viral infections of the eye. The most common side effect is a temporary burning sensation. Other side effects include eye redness, discharge, watery eyes, eye pain, foreign body sensation, itching, stinging, and blurred vision.

Please see product information for RESTASIS® Ophthalmic Emulsion.

Allergan, Inc.

© 2008 Allergan, Inc. All rights reserved | Privacy Statement | FAQs | Terms of Use | Site Map | Contact Us
This information is intended for residents of the United States. ® and ™ marks owned by Allergan, Inc.