Patient Contact Form

Complete “Your Information” on the form below to get more information about the AllergyEasy^® program or to find an AllergyEasy physician in your area.

To have your own family physician prescribe AllergyEasy drops for you, print this form and take it to them. Complete “Your Doctor’s Information” (below) so we can follow up with them.

You may also call us at 1-877-2SNEEZE (276-3393).

First Name * Last Name * Street Address * City * State * Postal Code * Phone * Email * Physician Name (if you would like us to contact them) Physician Phone Comments   Submit