EpiQuin® Micro

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EpiQuin Micro Rebate Survey

To become eligible for the EpiQuin Micro Rebate, 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.

* indicates a required field.

*Have you ever had or do you currently have any of the following conditions?

	Melasma (symmetrical dark brown patches on sun-exposed areas)
	Postinflammatory hyperpigmentation (dark brown patches from acne or other inflammatory conditions)
	Both melasma and postinflammatory hyperpigmentation

*Which statement best describes your current status?

	I am not sure if I have melasma or postinflammatory hyperpigmentation
	I have melasma/postinflammatory hyperpigmentation, but currently do not treat
	I treat on my own without prescription products
	I have an EpiQuin Micro prescription and want more information
	I have a prescription for one of the following, but want more information on EpiQuin Micro

*Which of the following treatments have you tried (check each product that applies)?
Claripel™
EpiQuin® Micro
Glyquin-XM® (hydroquinone 4%)
Tri-Luma (hydroquinone 4%)
Lustra® (hydroquinone 4%)
Lustra AF® (hydroquinone 4%)
Lustra Ultra® (hydroquinone 4%)
Aclaro™ (hydroquinone 4%)
Solage®
Generic (hydroquinone 4%)
Other treatment
None

*Gender	Male Female
*E-mail address
Please enter your mailing information below:
*First Name
*Last Name
*Address
*City
*State
*Postal code
*Phone
*Physician Name

Claripel™ is a trademark of Steifel Laboratories Inc. Glyquin-XM® is a registered trademark of ICN Pharmaceuticals. Lustra®,Lustra AF® and Lustra Ultra® are registered trademarks of Medicis Pharmaceuticals. Tri-Luma® and Solage® are registered trademarks of Galderma Laboratories, L.P. Aclaro™ is a trademark of JSJ Pharmaceuticals.

EpiQuin Micro should be tested for skin sensitivity prior to use. Excessive inflammatory responses are contraindications to further use, while minor redness is not. Hydroquinone may produce unwanted effects if not used as directed. The safety of topical hydroquinone use during pregnancy has not been established.

View full prescribing information. (PDF)

The product information provided in this site is intended only for residents of the United States.