Free. Easy. Fast.

See how simple it is to make a Sample Center request.

Check Eligibility & Register

Request samples in a few easy steps.

Sign In or Check Eligibility

Enter your last name and NPI number.

Select Medication Samples & Savings Offers

Choose the samples you want.

Confirm Credentials & Sign

Print, sign, and fax the Sample Request Form; or simply sign with your finger on your mobile device.

Receive Samples

Medication samples typically arrive within 4 to 6 business days of your order.

Distribute Samples to Appropriate Patients

Patients appreciate that they can get started on their treatment right away at no cost.

Ready to request samples?

Check EligibilitySign In