Levitra Medication
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LEVITRA (Vardenafil HCl)
Get 3 Free LEVITRA With a Prescription

You can get 3 free LEVITRA tablets with a prescription for LEVITRA from your doctor. LEVITRA is used to treat men with ED.

Just print the voucher, take it to your doctor, and if LEVITRA is right for you, he or she will write a prescription for LEVITRA. Take the voucher and your prescription to your pharmacy and receive 3 free tablets. This offer is good with 1 prescription. No refills.

To receive your 3-for-free voucher, complete the information below.

We respect your privacy, so rest assured that this information will only be used to fulfill your request and will be kept confidential.

*Required field.


Gender Male    Female
*First Name
*Last Name
*Address Line 1
  Address Line 2
*City
*State
*Zip
*E-mail
*Birthdate
Print this voucher for your partner to take to his doctor.
We ask that you answer the remaining questions on behalf of your partner.

*My partner's birthdate

*1. Which statement best describes you?
*1. Which statement best describes your partner?
Already consulted health care provider about ED
Plan to consult health care provider about ED
Just looking for information about ED

*2. Are you currently taking anything to improve erectile function?
*2. Is your partner currently taking anything to improve erectile function?
LEVITRA® (vardenafil HCl)
Viagra® (sildenafil citrate)
Cialis® (tadalafil)
Other prescription
Herbal supplement
Nothing

*3. What have you taken in the past to improve erectile function?
*3. What has your partner taken in the past to improve his erectile function?
LEVITRA® (vardenafil HCl)
Viagra® (sildenafil citrate)
Cialis® (tadalafil)
Other prescription
Herbal supplement
Nothing

*4. How frequently do you use an ED medication?
*4. How frequently does your partner use an ED medication?
Daily
2-6 days per week
Once a week
Less than once a week
Never

5. Please indicate if you have experienced any of the following conditions:
   (check all that apply)
5. Please indicate if your partner has experienced any of the following conditions:
   (check all that apply)
Diabetes
High blood pressure
High cholesterol
Depression
Prostate condition
Smoking

By providing your name, address, and other information, you are giving Schering-Plough Corporation, GlaxoSmithKline (GSK), and companies working with Schering-Plough and GSK permission to provide you with additional information regarding LEVITRA. Schering-Plough and GSK will not sell or transfer your name, address, or e-mail address to any other party for its own marketing use.

*Do you wish Schering-Plough Corporation, GlaxoSmithKline (GSK), and companies working with Schering-Plough and GSK to provide you with additional information regarding the men's health conditions in which you have expressed an interest? Schering-Plough and GSK will not
sell or transfer your name, address, or e-mail address to any other party for its own marketing
use.

Yes, please send me additional men's health information.
No, I do not wish to receive additional men's health information.

Viagra is a registered trademark of Pfizer, Inc.
Cialis is a registered trademark of Lilly ICOS LLC.