Sample Request

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Note: This offer is for MEDICAL PROFESSIONALS ONLY. An address for a medical office is required. Addresses that cannot be confirmed will be removed. Please DO NOT ENTER YOUR HOME ADDRESS - we will not ship to residential addresses.

Medical Sample Request Form

Name(Required)

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Phone(Required)

Email(Required)

Profession(Required)

What is your profession?(Required)

Interests(Required)

Poison Oak and Ivy

Head Lice Treatment

General Anti-Itch

Minor Wound Care

Other or New Product Launches

Company Name

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Spanish needed (Available for head lice literature only)(Required)

Resources

Head Lice Information

Images & Video

Treatment Information

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This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Sample Request

Sample Request

Please share your details in the form below, we will get in touch soon

Medical Sample Request Form

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