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 is for my personal evaluation	YES NO
Address should be able to recieve Postal, UPS or Fedex Package
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NeilMed Pharmaceuticals, Inc., 601 Aviation Blvd, Santa Rosa, CA 95403
TEL: 707-525-3784 | FAX: 707-525-3785 | TOLL FREE: 1-877-477-8633

Patent Numbers: USA-6,520,384 / 6,669,059 / 6,688,497 Canada-2,443,970 Australia-09/845,759
New Zealand-534041 Mexico-Pa/a/2003/009867. Other patents issued or pending internationally.

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