Sign up now to receive the Dulcolax®

Please fill out the form below to sign up for the Dulcolax^® Newsletter and stay up-to-date with the latest news and information on digestive health and receive healthy, high-fiber recipes. In addition, you will receive Dulcolax^® news, coupons, and special offers—all delivered right to your inbox.

*First Name:
*Last Name:
*Zip Code:	-
*Date of Birth:	(MM) (YYYY)
*Email:

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

1. What is your gender?

Male
Female

2. Which Dulcolax^® products are you most interested in? (Check all that apply)

Dulcolax Balance^®
Dulcolax^® Laxative Tablets
Dulcolax^® Laxative Suppositories
Dulcolax^® Stool Softener

3. Which of the following types of products, if any, have you used to prevent or treat constipation or irregularity in the past 2 years? (Check all that apply)

Overnight laxative tablets
Stool softeners
Milk of magnesia
Suppositories
Fiber
Probiotics
Enemas
Salines
Osmotic laxatives or Polyethylene Glycol 3350
I haven't used any of these types of products to prevent or treat occasional constipation

The information you are providing will be used by Boehringer Ingelheim Pharmaceuticals, Incorporated so that we may advertise our products to you and provide you with information about them. We respect your right to have personal and medical information kept confidential. Companies working with us will use the information you provide to send you information, seek your opinions, and help develop products, services, and programs. If we provide you with coupons or vouchers for our products, the information we receive from the pharmacy regarding their use will also be used for the same purposes. We won’t share your private information with anyone else, including mailing lists.

By checking here, you indicate that you agree to our Privacy Statement and allow us to use your information to advertise disease states, branded product and other products to you. Boehringer Ingelheim may also provide you with useful materials and contact you about health-related topics. If you do not check the box, you will only receive the materials you requested, and will not receive any ongoing communications.