Request a FREE Incontinence Garment Sample

Please complete this form to receive a free sample of select incontinence products. A sample will be provided and shipped to a physical US mailing address (excluding P.O. Boxes) at no cost to you. *Certain restrictions and limitations apply. You agree to be contacted with follow up questions pertaining the samples dispensed.
  • Please enter the name of the recipient.
  • If entering request on behalf of a client, please disclose Your email address.
  • Must be a valid US mailing address. No P.O. Boxes.
  • Valid US phone number.
  • Please select the requested size(s). Waist dimensions are an approximation, based on the brand/product selected.
  • Please select the requested absorbencies (max 3, hold Ctrl & left click to select additional items).
  • Please enter a brief description regarding the need for incontinence supplies. (Information regarding daytime or night time use, incontinence frequency, and absorbency level is helpful in determining what samples to send). Height and weight is also helpful in determining the correct incontinence care.
  • This field is for validation purposes and should be left unchanged.