NeoBenz Micro Instant Savings Voucher

To become eligible for the NeoBenz Micro Instant Savings, please complete the following survey in its entirety. You must be 18 years or older to participate. After completing the survey you will be able to print out the rebate certificate.

 

* First Name
* Last Name
* E-mail
* Address
 
* City
* State
* ZIP Code:
* Your Gender:
Male    Female
* Your Age:

* What brings you to neobenzmicro.com?

I want more information about acne and do not have a prescription for NeoBenz Micro
I want more information about NeoBenz Micro before filling the prescription my doctor gave me
I am a current user of NeoBenz Micro

* Have you been to the doctor to learn more about acne treatments?

Yes : No

If you have acne, how long have you been treating your acne?

0 - 1 years
1 - 3 years
3+ years
I have not been treating it

If you've been treating your acne, with what products have you been treating it?

Only with over-the-counter acne medications
Only with prescription acne medications
With both over-the-counter and prescription acne medications
I have not been treating my acne

If you've been using NeoBenz Micro, how long have you been using it?

Less than 1 month
1 - 3 months
3 - 12 months
More than 1 year

* Have you used any other prescription benzoyl peroxide products in the past?

Yes  No
If yes, were they?
Over-the-counter  Prescription  Both  

 

I wish to receive informational emails about other SkinMedica products.

By submitting this form you agree to receive information about NeoBenz Micro, and is checked so above, other SkinMedica products.

 

 

HOW TO RECEIVE YOUR INSTANT SAVINGS VOUCHER

In order to receive your $35 instant savings on NeoBenz Micro, please fill out the form to the left and hit 'Submit'. Then print out and follow the directions provided on the Instant Savings Voucher.

YOUR PRIVACY

The personal information requested will be used to fill your NeoBenz Micro instant savings, aggregate research and, if indicated, promotional purposes only. To protect the privacy of our users, your information will not be sold to a third party. Read our Privacy Policy for more information.