Patient Program Redemption Form


Fill out the redemption form below!

    Basic Info

    Delivery address

    How did you hear about this promotion?

    OphthalmologistOptometristPharmacistOpticianSocial MediaCandorvision websiteFlyerWord of MouthOther

    The submitted box flaps with barcodes (10 total) are from:
    (check all that apply)





    Instructions: This completed form must be shipped with a total of ten (10) original barcodes from the bottom flap of each HYLO® treatment retail box and all original purchase receipts, which will not be returned. Please keep a copy of this form for your records.

    WARNING: Tampering with, altering, or falsifying purchase information related to your HYLO®, HYLO®-DUAL, HYLO®GEL or HYLO DUAL INTENSE™ bottles constitutes fraud and will result in your submission being denied. Please do not submit via Registered Mail. No substitution or transfer allowed. Only an eye care practitioner can tell you which dry eye treatments are best for you.

    Terms and Conditions: Offer valid for Canadian residents only and for qualifying HYLO®, HYLO®-DUAL, HYLO®GEL, HYLO DUAL INTENSE™ bottles purchased in Canada within the given deadlines (January 1st 2022 to December 31st 2022). This offer is only valid for goods manufactured by Candorvision and purchased at authorized physical retail locations (Canadian pharmacies and optometry/ophthalmology clinics) or through their accredited online stores. Samples are excluded. Valid only when accompanied by ten (10) original barcodes cut from the bottom flap of each retail box (showing the barcode, expiry date and lot number), corresponding original proof of purchase receipts for each bottle as well as the completed redemption form. The bottle(s) (HYLO®, HYLO®-DUAL, HYLO®GEL, HYLO DUAL INTENSE™) awarded through this promotion will correspond to the product of lowest value for which valid original barcodes from the bottom flap of the box and original receipts have been received. Offer not valid if submitted by wholesalers, dealers, retailers, or other commercial entities. Requests from those with an invalid or undeliverable mailing address will be denied. Limit of four (4) free bottles per program. The completed redemption form, original proof of purchase receipts and original barcodes cut from the bottom flap of each retail box (showing the barcode, expiry date and lot number), must be postmarked at your expense and will not be returned. The mailing address provided on the completed redemption form will be used to fulfill submitted claims. Candorvision is not responsible for late, lost, stolen, misdirected, illegible, mutilated, or postage due mail. Void where restricted or prohibited by law. This offer does not apply to those located in remote or hard-to reach areas. All decisions made by Candorvision regarding the validity of any submission are final and binding. Candorvision reserves the right to request additional information to substantiate a claim. For privacy reasons, you may modify your receipts to hide payment information and other purchases, so long as any information relevant to this Patient Program remains visible. Receipts must show the following purchase information: date, store name, item purchased, quantity of items, purchase price and payment confirmation. Barcodes submitted must be original barcodes cut from the bottom flap of each retail box (showing the barcode, expiry date and lot number). Please allow a maximum of 6-8 weeks for fulfillment. This offer cannot be combined with any other offers from Candorvision, unless stated otherwise. For all questions contact us at or (514)380-5270.

    PRIVACY: Your privacy is important to us. Your email address will only be used to communicate your submission status, unless you subscribe to receive information about new products and promotions.

    Please scroll through and carefully read and agree to the Terms & Conditions to submit your form.

    You will receive a confirmation e-mail with your filled out form and instructions.

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    CP 23073 Montreal, Canada, H4A 1T0