Doctor Samples

Doctor Samples Program

REVIVOL-XR Advanced Hemorrhoid Cream is available as a free sample for verified healthcare professionals. Submit the application below. We verify your NPI on the public NPPES registry and confirm that the delivery address is a business location. Approved clinicians receive five sample tubes shipped to the practice at no charge, with an order confirmation and tracking by email. Applications are reviewed twice a week; most are approved within 3 business days.

Limit: 5 sample tubes per clinician every 30 days. Samples ship only to a clinic, medical office, hospital or other verified business address, never to a home. To request a refill after 30 days, submit the form again with the same NPI.

Eligibility

Active US healthcare professionals with a valid individual NPI number. Eligibility may vary by specialty.

Priority specialties: Gastroenterology, Colon & Rectal Surgery, OB-GYN, Family Medicine, Internal Medicine, Urgent Care, NP/PA/CNM, PharmD. Other specialties reviewed case-by-case.

Application Form

Samples are for patient evaluation and education only. No purchase, recommendation or review is required. Please do not include any patient information.

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