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Register for Vision Matters™ Now

To sign up for the free Vision Matters program, please enter your information below and click "Submit." You should receive your welcome packet in the mail in about 2 weeks.

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*First Name:
     
*Last Name:
     
*Address:
     
Address 2:
     
*City:
     
*State:
     
*ZIP Code:
     
Phone:
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E-mail     

So we can help give you information of interest, please fill out the following:

1. Have you been diagnosed with any of these? (Check all that apply)

High eye pressure
Optic nerve damage
Glaucoma
Macular degeneration

Approximate date of first diagnosis (please enter in format: MM/YYYY):

      

2. Have you ever been prescribed XALATAN for the conditions above?

Yes No

3. Are you currently taking XALATAN for the conditions above?

Yes No
Along with the material you asked us to send, Pfizer may want to contact you from time to time about special offers and updates on XALATAN and related health issues. Check here if you would like this information.
Check here if you also agree that Pfizer and companies working with Pfizer may use your information to help develop Pfizer products, services, and programs, provide you with materials you may find useful, and contact you about health-related topics.

If you do not check either box, we will fill just this one-time request.