Patient Sample Kit Request Form

Interested in free samples for your patients?  Each kit contains:

  • 30 samples of oral electrolyte powder + a $2 coupon off any Hydralyte product
  • A small, desk-top easel stand with coupon pad
  • A usage directions tear pad with coupons

More than $160 of value for your patients!

Already have samples but need a refill? No problem! Fill out the form below and we’ll send you another kit.

    This is so we can send the most appropriate information and samples to you. This request form is for healthcare professionals only.

  • This is so we can verify your address / profession. Unfortunately we cannot send samples without being able to verify your place of work as a healthcare provider.




Healthcare Professionals

Request Patient Samples

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