Contact Us

  • Please make a selection.
  • Please tell us if you've taken the brand or generic form of Zantac.
  • Please make a selection.
  • If so, which type of cancer were you diagnosed with? (Please check all that apply.)
  • Please enter a message.
  • Please enter your first name.
  • Please enter your last name.
  • Please enter your email address.
    This isn't a valid email address.
  • Please enter your email address.
    This isn't a valid email address.
  • Please enter your primary phone number.
    This isn't a valid phone number.
  • This isn't a valid phone number.
  • Please enter your city.
  • Please make a selection.
  • Please enter your zip code.
    This isn't a valid zip cide.
  • Please make a selection.
  • Please make a selection.