Request Free Samples of Cure Medical  Intermittent Catheters

 
 
 
 
Please provide your information below
 
 
 
 
First Name*
 
 
 
 
Last Name*
 
 
 
 
State*
 
 
 
 
 
 
 
Check this box if you are a Healthcare Professional.
 
 
 
If you are a retailer, DME or HME, please click here to contact us. 
 
 
 
 
How can we contact you?
 
 
 
 
Email Address*
 
 
 
 
Phone Number*
 
 
 
 
Phone Number Type
 
 
 
 
 
 
 
Are you a current or recently prescribed intermittent catheter user?*
 
Yes
No
 
 
 

A valid prescription is required in order to sample intermittent catheter products.
No payment information required. 

 
Cure Medical, LLC was acquired by ConvaTec Inc. By submitting your information, you are agreeing to ConvaTec's Privacy Policy and Health Information Consent Policy. If you would like to order ConvaTec's products, you authorize ConvaTec to identify and transfer you to a designated ConvaTec retailer. 
I agree to the above privacy statement.*
 
 
 
 
 
 
You authorize ConvaTec to call, email, text or mail you information about ConvaTec's products and services. You may withdraw this authorization by contacting us at 1-800-422-8811, GC-US@convatec.com, or by mail at PO Box 270603, Oklahoma City, OK 73137. 
I agree to the above marketing statement.