Just Complete This Simple Form And We'll Send You
FREE INTERMITTENT CATHETER SAMPLES!
(Sorry, USA only. Prescription may be required.)
Complete the information below and press the SUBMIT button to send your
request. To move around the form in order, press the tab key. Please be as
complete as possible so we can send your samples quickly. If you need help
filling out this form, we will be happy to take your request by calling us at:
In Hampstead call 270-2200 - Outside Hampstead, Toll-Free 888 270-2353
Mon- Thurs.. 9 a.m.-5 p.m Friday close at
In order to receive your free samples, you must provide us with your mailing
address and telephone number, along with the information we ask for below
relevant to your request. We may contact you via telephone to verify your
request, or if we need further information to determine the appropriate size or
type of the product you've requested. Thank you for allowing Heartline Medical
offer you our finest services.