Relationship *: (Enter the relationship of the caregiver)
Mobile/Cell Phone*: Enter your mobile/cell phone number. Example: 88888888
E-mail : (Enter your email. Example: firstname.lastname@example.org)
Create your password to access your personal account *:
Confirm your password to access your personal account *:
With your card and this password, you can check your account statement by entering the private section that you will find in the upper right of this page.
Do you have a AZCode?
An AZ-CODE is a code (of numbers) that you may have received from your doctor to benefit from an initiation of treatment of your newly prescribed medication. If so, enter it here and request it at the pharmacy
Other Doctor (AZcode)
Do you have a Pulmicode?
Dear Patient, we comment you that for the delivery of the nebulizer benefit for the purchase of a box of Pulmicort, it is subject to the coverage of delivery areas delimited by DHL, wich is responsible for this part of the process. To select you preferred area, complete the data in the form -Delivery address-
I want to pick up at DHL branch
I want the product to be sent to my home
By clicking on the submit button, you will be a patient enrolled in the program, please click on the link or link you will receive by email or text message (SMS) so you can receive the benefit of the exchanges. Make sure the email has not fallen into your spam or spam tray.
Your data will not be shared with third parties. They will only be used for respective communications of the program.