Sample Request You can request a sample by calling 877-443-3524 or you can submit information to us with the form below Your Name (required) Your Email (required) Your Phone Number (required) Facility Type —Please choose an option—Acute CareHospitalRehab HosptialOther Your Role —Please choose an option—AdministratorLogisticsOrthopedicRegistered NurseOther Vendor/GPO Shipping (optional, but preferred) Facility Name Street Address Street Address 2 City State Postal Code Attention Room Number Additional Comments