Clinician’s Library& Sample Requests
This secure sample request form is for Healthcare Professionals only.
If you have any issues
submitting your request call us on 03452 222 205 or email email@example.com
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.
Patient details are deleted. The GP/ Surgery details and Nursing Home details are retained to advise samples have been sent and ensure they have arrived.
All samples are dispatched within 24 hours of your request.
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 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.