Professional Sampling for Prilosec OTC

Helping Patients Maximize Medicare Part D Coverage;Learn More

Professional Sampling

Registration

To register for free professional samples of Prilosec OTC and Medicare Part D kits for your patients, please fill out the form below.

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*Indicates required fields

Enter your DEA # and select the Quick Start button. If your information is on file, this will fill out much of the form below for you.

* DEA number:

* First Name:

Middle Initial:

* Last Name:

*Physician Type:

Nurse Practitioners

* Company Name:

* Address 1:

Address 2:

* City:

* State:

* Zip Code:

* Phone Number:

—

Area Code

* Email Address
(This will be your username):

* Confirm Email Address:

* Password:

* Please re-enter your password:

* Date of Birth:

Month

Day

Year

* I verify that I am a Medical Provider.

Important Information — Please Note:

Trust is a cornerstone of our corporate mission, and the success of our business depends on it. P&G is committed to maintaining your trust by protecting personal information we collect about you, our customers.

Click here for the full details of our Privacy Statement

We take great care to keep the personal information you give us secure. P&G does not give information to other marketers. At your request, we will send you communication such as free product samples, previews of new products, or personalized offers. We may also ask for comments on how to improve our products and services. Click here for details of our privacy policy.