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Signing up for Pfizer Préférence is simple.
It only takes a few minutes to enroll. Simply enter your personal information in the form below and submit.
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Pfizer Préférence Enrollment Form
Date of Birth
Type of Coverage
My private insurance covers
% of prescription drug costs.
Typically, private insurers reimburse between 67.5% and 100% of prescription products. Please review your plan policy and re-enter your percentage coverage for prescription products.
Street No and Name
Unit / Apartment No
Personal information such as your name, home and email address, phone number and Pfizer brand product of interest collected from you will be used by Pfizer Canada Inc. (“Pfizer Canada”) to offer you general health-related information and educational tools, newsletters, as well as program related updates on our products (such as payment assistance if available for the Pfizer brand product you have selected). Your personal information may be shared with service providers in order to provide you with the products/services/information that you have requested, but will not be otherwise disclosed without your consent, except as permitted or required by law. Your personal information may also be disclosed and/or transferred to a third party in the event of a proposed or actual purchase, sale (including a liquidation, realization, foreclosure or repossession), lease, merger, amalgamation or any other type of acquisition, disposal, transfer, conveyance or financing of all or any portion of Pfizer Canada or of any of the business or assets or shares of Pfizer Canada or a division thereof. Please note that sharing of personal information with service providers or disclosures to third parties may involve the storage or processing of personal information outside of Canada (including in the United States) where local privacy laws may require the disclosure of personal information to governmental authorities under circumstances that are different than those that apply in Canada.
By submitting your personal information and electronic address, you consent to the manner of collection, use and disclosure of personal information as described above as well as consent to receiving electronic communications containing information and updates from Pfizer Canada Inc. relating to general health-related information and educational tools, newsletters, as well as program related updates on our products (such as payment assistance if available).
If you later change your mind about such collection, use and disclosure for any reason, you may withdraw your consent, by contacting Pfizer Canada as set forth below. You have a right to access and correct your information, where required. If you have any inquiry concerning your personal information, please contact Pfizer Canada Inc. at P.O. Box 800, Pointe-Claire – Dorval, Quebec H9R 4V2 or by phone at 1-888-637-5464. Further information about Pfizer Canada's privacy practices is available at
I have read, understood and consented to the
I certify that the information provided to the program for this submission is accurate.