Download an
enrollment form

Fax the completed
form to: 1-844-868-6329

Mail the completed form to:
Pfizer IGuide™, PO Box 220692,
Charlotte, NC 28222

Enrollment in the
program begins as
soon as Pfizer IGuide™
receives the
Enrollment Form.

ENROLL PATIENT

including BOXED WARNING

including BOXED WARNING

including BOXED WARNING

including BOXED WARNING

Enrollment Form

Download

Spanish Enrollment Form

Download