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How to get your rebate |
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download printable rebate
form
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Mail to:
Beechwood Associates, Inc.
PO Box 1190
Morrisville, NC 27560-9914 |
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First Name:____________________________________________________ |
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Last Name:____________________________________________________ |
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City:_______________________State:________________Zip:__________ |
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E-mail (required):_______________________________________________ |
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Phone (optional):_______________________________________________ |
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1. How often do you experience bacterial vaginosis (BV)?
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2. What is most important to you in a BV treatment?
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3. What do you like best about Clindesse?
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4. How long did it take for you to begin feeling symptom relief?
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5. Would you use Clindesse again?
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6. Where did you hear about Clindesse?
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7. How did you find out you had BV?
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8. If you have previously used another BV medication, why did you switch to Clindesse?
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Certificate# |
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Plan# |
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| I hereby certify that I meet the eligibility requirements and wish to participate in this program:
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Patient Signature:______________________________________________ |
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Date:________________________________________________________ |
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| Eligibility Requirements
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| In order to be eligible for this offer, you must be responsible for at least $15.00 of the cost of this prescription yourself (if your prescription is not covered by insurance or if your insurance co-pay is at least $15.00). You are not eligible for this offer if all or any part of the cost of your prescription is covered by a federal healthcare program, including Medicare or Medicaid, or by any similar federal or state program, including a state pharmaceutical assistance program. If you are a resident of Massachusetts, this coupon is valid only if you are paying the entire cost of the prescription yourself (ie, your insurance does not cover any of the cost of your prescription). Your acceptance of this offer must be consistent with the terms of any drug benefit provided by your health insurer, health plan, or private third-party payer, and you must agree to report acceptance of this offer to your health insurer, health plan, or third-party payer as may be required. This offer may not be used with any discount coupon or offer. Only originals of this coupon will be accepted. Offer void where prohibited by law, taxed, or restricted. Offer good only in USA. Ther-Rx reserves the right to rescind, revoke, or amend this offer without notice. Limit 1 per purchase.
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Clindesse® (clindamycin phosphate) Vaginal Cream, 2%, is indicated for the treatment of bacterial vaginosis in women who are not pregnant. Clindesse has not been adequately studied in pregnant women and should be used during pregnancy only as prescribed by your healthcare provider.
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See your healthcare provider in order to rule out other vaginal infections, such as yeast infection, trichomoniasis, chlamydia, and other sexually transmitted diseases, before using Clindesse.
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Do not use Clindesse if you have had a reaction to clindamycin, lincomycin, or any other Clindesse ingredients. Clindesse should not be used if you have experienced inflammation of the intestine or colon.
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| Important Safety Information |
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This cream contains mineral oil that may weaken latex or rubber products such as condoms or vaginal contraceptive diaphragms. Use of these birth control methods is not recommended during—or for 5 days following—treatment with Clindesse. During this time period, condoms may not prevent pregnancy or protect against HIV and other sexually transmitted diseases.
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Talk to your healthcare provider if you experience diarrhea after treatment with Clindesse. Though rare, it may be indicative of colon inflammation.
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The most frequently reported Clindesse side effects were fungal vaginal infection, vulvovaginal itching, and headache.
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