Dulcolax®

Coupons & Special Offers

Thank you for your interest in Dulcolax^®!
Please select the Dulcolax^® offer(s) you're interested in:

Please fill out the fields below to receive your savings on the Dulcolax^® product(s) of your choice.

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

What is your gender?

Male
Female

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

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

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 about to provide 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 information from redeemed coupons and/or vouchers we have provided you, which we receive from the retailer, 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).

	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 Dulcolax^® 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 Dulcolax^® and other products to you. Boehringer Ingelheim may also provide you with useful materials and contact you about health-related topics.