PC Pfizer Extended STG Test First Name Last Name Date of Birth: Email Phone City State/Province I have an immediate need:–None–YesNo By selecting this box, I attest that I am a parent, parent-in-law, parent-in-law of a domestic partner or adult child of a Pfizer employee covered under the U.S. Pfizer Medical Plan CHECK BOX (REQUIRED): By selecting this box, I agree to the Terms and Conditions. CHECK BOX (REQUIRED):