This secure sample request form is only for Healthcare Professionals only.
If you want us to send samples direct to your patient, simply complete the form below. Or if you would like multiple samples to try with your colleagues or keep in your Department please email what you would like, with your address to firstname.lastname@example.org
Please note when the form is submitted the data sent is held securely (128 bit encryption) for 24 hours whilst we process the request. It is then deleted from our server. All samples are dispatched within 24 hours of your request.
If you want us to email the recipient to tell them their samples are being posted, please add it below.
We do not keep their email or send marketing material.
As you’ve asked for a sample, we will add you to our monthly newsletter to
keep you up to date with our developments and others in the dysphagia world.
NOTE: We will NOT contact the Recipient of except in connection with their sample
To ensure you receive them please add email@example.com to your contacts in Outlook
If you prefer not to receive Slõ News please untick this box.