NeilMed Pharmaceuticals, Makers of Sinus Rinse, NasaFlo Netipot, Nasal Irrigation

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Sample Request Form For Medical Professionals Only

Please check desired products you would like to recieve Free Samples of....


Sinus Rinse™ Kit	Sinus Rinse™ Pediatric Kit	NasaFlo^® NetiPot	NasoGel^®Tube

NasoGel^®Spray	NasaMist^®Isotonic	NasaMist^® Hypertonic	NasaDock^®

» 24-page Educational Rhinosinusitis Brochures	50 100
» May we place your name on our mailing list for samples and educational brochures to be sent every 3 months?	YES NO
» These samples requested are for my personal evaluation	YES NO
Address should be able to receive Postal, UPS or Fedex Package
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Numéros de brevet: États-Unis -6,520,384 / 6,669,059 / 6,688,497 Canada-2,443,970 Australie-09/845,759
Nouvelle Zélande-534041 Mexique-Pa/a/2003/009867. Autres brevets internationaux délivrés ou en instance.

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