GoodRx Kits Opt-Out Form
To ensure that we place the correct information onto our DO NOT MAIL list, please fill out this short form with the information from the shipping label on the box. We apologize for any inconvenience that this may have caused you.
Recipient NPI (if applicable)
Recipient Title (i.e. Dr., Mr. Mrs., etc)
Recipient First Name
Recipient Last Name
Organization/Company
Address *
City *
State *
Zip *
Why are you opting out of receiving GoodRx kits? *
Please provide us with any additional feedback or comments that you feel is necessary.
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