HylatopicPlus Coupon

Instant Rebate

Pay No More than $25 for Hylatopic^®, HylatopicPlus^® or the HylatopicPlus - Aurstat Kit¹

Register below to print your Instant Rebate Coupon and pay no more than $25 for your Hylatopic^®, HylatopicPlus^® or your HylatopicPlus - Aurstat Kit prescription. Insured patients and the majority of patients paying with cash can take advantage of this instant savings. Keep the instant rebate coupon for future use, as it can be used up to three times.

¹Please read IMPORTANT NOTICE on back of coupon to determine if you are eligible for this offer. This offer is void where prohibited by law.

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* Required fields

First name^*

Last name^*

Email^*

Confirm email^*

Address

Address (continued)

City

State

Zip code

Gender^*

Male
Female

For what condition did your doctor prescribe this product?*

Atopic Dermatitis
Contact Dermatitis
Radiation Dermatitis
Dry Skin
Other

For what part of your body did your doctor prescribe this product?*

Face, hands, and other parts of body
Face and hands only
Face only
Hands only
Body, but not hands and face

By checking this box, I confirm I am 18 years of age or older.^*