Rain Subscription Adjustment Form

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How would you like to adjust your Rain prescription plan?* This field is required.
Skip my next refill — Push my next shipment back by 2 months.
Pause my plan for 3 months — Take a longer break and keep your prescription active.
Cancel my prescription plan
Something else — I want to talk to someone.
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Before you go — here's what cancelling means.When you cancel your Rain prescription plan, you'll lose: *Your active prescription — cancelling ends your current prescription. To restart, you'd need to complete a new intake and doctor's visit. *Free shipping on every refill *No physician fees on refills (you'd pay the visit fee again on any future plan) *No new intake forms to fill out — your provider relationship stays in place *No gaps in your treatment — chronic dry eye comes back when prescription treatment stops If you've been on Rain for a while, your eyes have likely adjusted to the medication. Stopping and restarting can mean going through the adjustment period all over again. Question: Would you like to keep your benefits with one of these instead?
Skip my next refill (push it back 2 months)
Pause my plan for 3 months
Continue with cancellation
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What's the main reason you're cancelling?
The medication isn't working for me yet
I'm experiencing irritation or some side effects
Cost — I need a more affordable option
I have too much supply already
I'm getting my prescription elsewhere
Other
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Cyclosporine eye drops take time. Here's what's normal. Most patients don't see meaningful results until weeks 4 to 8 — and a real, lasting difference often shows up between months 2 and 3 of consistent use. Stopping early is the most common reason people don't see results. Your eyes are doing the work right now, even if you don't feel it yet.Question: What would you like to do?
Keep going — I'll give it more time
Skip my next refill and use what I have
I still want to cancel
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Some irritation is normal at first. Cyclosporine eye drops commonly causes mild burning or stinging in the first few weeks of use — for most patients, this fades as the eyes adjust to the medication. If your irritation is more significant or isn't improving, your provider can help. You can message them anytime through your patient portal at rx.feelrain.com.Question: What would you like to do?
Keep going — I'll give my eyes more time to adjust
Skip my next refill and reassess
I still want to cancel
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Let's just push your next refill back.Question: How long would you like to delay?
Skip my next refill (2 months)
Pause my plan for 3 months
I really do want to cancel my treatment
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One last thing before you go. Stay on your plan and get 15% off your next 2 refills. Your next 2-month refills drop from $199 to $169.15 — that's just $84.57/month, billed every 2 months. Same medication. Same provider. Same delivery. Just a better price for staying consistent — which is exactly what your eyes need.Question: Would you like to apply the discount?
Yes, apply the 15% discount and keep my plan
No thanks, continue with cancellation
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Got it. Let's locate your subscription.* This field is required.Please provide some basic information so we can take of this for you.
First Name
Last Name
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Email address used for your subscription order* This field is required.
example@example.com
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Phone Number* This field is required.
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