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This program is only available to residents of the United States and US territories (including the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands), except where prohibited. This program is valid for most eligible commercially insured and most eligible uninsured patients. Individuals who are enrolled in, or eligible for reimbursement under a government health care program, including Medicare, are not eligible to participate in this program. Terms, conditions and limitations apply. If your insurance changes, you may no longer be eligible to use this coupon.

To activate your coupon, please answer the following questions:

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Please enter a valid 10-digit GRP#.
Please enter a valid 11-digit ID#.
Please select Yes or No.
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