Sample Request

Digital Tourniquet
(4 sizes)

Digital Tourniquet
(universal size)

Nasal Foreign Body Remover

Abscess & Cyst Drain

Samples are only intended for medical professionals located in the USA

Product Sample*
- Tourni-Cot
- Uni-Cot
- Balloon Extractor
- Derma-Stent
Full Name*
First Last
Email*
Phone*
Specialty
Institution Name*
Position*
Shipping Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Why are you requesting a sample device?*
How did you hear about us?*
What is the percent (%) chance this request leads to your facility adopting our device(s)?*
Is there any further information or assets we can share with you to increase the percentage above?*
Any Additional Comments/Notes We Should Know?