Athletic Trainer Sample Kit Request Form

• 1 Stopain® Clinical Professional Brochure – For the Athletic Trainer to keep as an overview of the attributes and uses of Stopain Clinical
• 1 bag of 10 Stopain® Clinical Gel Sample Packets – For utilization of the product on your patients during treatment (samples are not single use packets and can be used for multiple treatments)
• 1 Stopain® Clinical Product Sales Sheet – Shows benefits and points of difference to competitive products, varying products in the line, and in-office sales support material.

* denotes required field

First Name*

Last Name*

Practice*

Email*

Number of Clinics *

Number of Doctors *

Number of Daily Patients Seen *

Current Analgesic Used *

Current Analgesic Distributor *

Shipping Attention Name*

Address*

City*

State*

Zip*

Promo Code

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