This form should not be completed by medical facilities looking for patient samples. Medical professionals must complete our Medical Partners Program form.
Form for Non-Profit, For-Profit, or Industry Reviewer
Please not that, as a company, we value and respect everyone’s freedom of decision to be aligned with affiliations of their choice. In order to avoid the endorsement of known, or unknown, impropriety by any given party or religion, we do not provide in-kind donations to political and religious organizations of any kind.
Lead Time
A minimum 6 weeks lead time is required in order to review your application and ship the donation.
Non-Profit or Event
Requesting samples for a non-profit organization, charity, or special event.
Medical or Professional
Requesting samples for use in a medical practice, clinic, or professional setting.
Non-Profit & Event Sample Request
Medical & Professional Samples
For all sample requests related to the medical field, clinics, or professional practices, please use our dedicated portal.
Go to Medical Partners Request FormNon-Profit or Event
Requesting samples for a non-profit organization, charity, or special event.
Medical or Professional
Requesting samples for use in a medical practice, clinic, or professional setting.
Non-Profit & Event Sample Request
Medical & Professional Samples
For all sample requests related to the medical field, clinics, or professional practices, please use our dedicated portal.
Go to Medical Partners Request Form