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I/MY FAMILY SUFFER(S) FROM ALLERGIES DURING THE FOLLOWING SEASONS:
(SELECT ALL THAT APPLY.)
Spring
Summer
Fall
Winter
All Year
WHICH CLARITIN ALLERGY MEDICATIONS DO YOU USE IN YOUR HOUSEHOLD?
(SELECT ALL THAT APPLY.)
Claritin® Tablets or Claritin® Liqui-Gels®
Claritin® RediTabs®
Claritin-D®
Children’s Claritin®
None at this time
WHAT ARE THE AGE GROUPS OF ALLERGY SUFFERERS IN YOUR HOME?
(SELECT ALL THAT APPLY.)
Age 18+
Ages 13 to 17
Ages 6 to 12
Ages 2 to 5
MM
YYYY
ELIGIBILITY

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I'm 18 years of age or older.
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