The Request Process

Requesting samples

  1. Check the box next to the samples you want and click Continue. If available, check the box to enable Recurring Requests.
  2. Choose your shipping address or add a new one.
  3. Enter your state license number.
  4. Click Confirm Sample Request.
    • Via fax: Click Print Request Form, fill out the form, and fax it.
    • Via mobile: Sign on your mobile device.

Printing vouchers and coupons

  1. Select the printer icon next to a brand.
  2. Enter the number of coupons or vouchers you’d like to print.
  3. Select Print Now.
  4. Give them to your patients with their prescription.

Who can request samples?

Only qualified physicians can sign to receive medication samples (using smart fax forms printed through the Sample Center). However, members of your staff (such as a sample coordinator) may assist in the process, just as they would in managing traditionally distributed orders.

Sample Request confirmation

You will receive an email confirmation whenever you successfully submit a sample request. Note that completing a request requires you to print, sign, and fax in the form, or sign on your mobile device.

Sample shipping speed

Medication samples typically arrive within 4 to 6 business days.