Sample Request


This form is for promotional events and product reviewers only. Medical professionals requesting samples to distribute to patients should join our Medical Partners Program.

Medical professionals click here

I understand this form is only for promotional events.

This form should not be completed by medical facilities looking for samples for clients, the correct form would be the Medical Partners Program form.

Form for Non-Profit, For-Profit, or Industry Reviewer

Lead Time

A minimum 6 weeks lead time is required in order to review and ship the donation.