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If you would like us to send you free information about quitting smoking, and information about a prescription treatment option, please complete the form below. All fields are required unless specified optional.

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Due to the personal nature of the materials and Pfizer's respect for the privacy of personal medical information, we can only send the materials directly to you.

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Privacy Statement:
Pfizer understands your personal and health information is private. Please read our Privacy Policy. The information you provide will only be used by Pfizer and parties acting on its behalf to send you the materials you requested and other helpful information and updates on smoking cessation and a prescription treatment option, as well as related treatments, products, offers, and services.

By checking this box, I also agree that Pfizer or companies acting on its behalf may send me materials about other health conditions, use my information to develop or improve products and services, or contact me in the future about health-related topics.

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The health information contained herein is provided for educational purposes only and is not intended to replace discussions with a healthcare provider. All decisions regarding patient care must be made with a healthcare provider, considering the unique characteristics of the patient.

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