
Step 1. Complete the information below and click the Submit button.
Step 2. A new window will open with your certificate for a FREE 4-week supply of ACTONEL. (Make sure to deactivate any pop-up blockers — this offer requires a pop-up window.) Print the certificate and take both your new prescription for ACTONEL and this certificate to your pharmacisist. You will need a new prescription to receive your sample.
Step 3. In a few weeks, you will also receive an osteoporosis information kit in the mail.
Note: This offer is limited to one certificate per patient for each 12-month period (provided as a sample).
Check here if you've already provided us with your contact information.
The information you give us will be kept strictly confidential and will only be used by Procter & Gamble Pharmaceuticals and sanofi-aventis U.S. to help us provide you with the materials that will help you the most. See our Privacy Policy.
Void where prohibited by law. Product is dispensed as a sample pursuant to terms of voucher. Cannot be submitted to any third-party payor, public (e.g. Medicaid) or private, for reimbursement. Not valid if reproduced or submitted to other payor. It is illegal for any person to sell, purchase or trade this sample voucher.
*Required information
ACTONEL is a prescription medication to treat and prevent postmenopausal osteoporosis.
You should not take ACTONEL if you are allergic to any of the ingredients, if you have low blood calcium (hypocalcemia), have kidneys that work poorly, or cannot stand or sit upright for 30 minutes. Stop taking ACTONEL and tell your doctor if you experience difficult or painful swallowing, chest pain, or severe or continuing heartburn, as these may be signs of serious upper digestive problems. Follow dosing instructions carefully to lower the chance of these events occurring. Side effects are generally mild or moderate and may include back, muscle, bone or joint pain, stomach pain or upset, or constipation. Contact your doctor if symptoms are severe. Tell all of your healthcare providers about all the medicines that you take. See Product Information. If you have questions, please talk to your doctor.
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