Hollister Sample Request

VaPro Plus Pocket™ No Touch Intermittent Catheters provide 100% no touch protection with a protective tip and sleeve.

Experience it for yourself now!

Please complete the following form to receive your free sample*

Alternatively, call us at 1.888.808.7456 (option 3).

Step 1

Step 2

Step 3

First Name*

Last Name*

Email*

Phone Number*

Gender* (The catheter has a length of 40cm/16in predominately used by male catheter users)

Who is the manufacturer of your current catheter?

What size is suitable for you?*

Address*

City*

Zip Code*

Address 2

How long have you been catheterizing?*

What is the brand name of the catheter you are currently using?

State*

Birthdate* (DD/MM/YYYY)

Which company currently sends or delivers your supplies?

Do you have an active prescription for catheters?*

For the purpose of receiving information about products, promotions, and other direct marketing campaigns, I consent to the processing of my personal identification, communication preference, health information, and request details, where applicable, by Hollister, which includes its Group Companies (see link below). I understand that Hollister and its Group Companies may communicate with me about these topics, using the contact information (postal address, email, phone, & sms text) that I have provided.

For the purpose of processing, fulfilling, and communicating with me about the order I am requesting,* I consent to the processing of my personal identification, communication preference, health information, product information, third party information, transactional information, and request details, where applicable, by Hollister, which includes its Group Companies (see link below). I understand that Hollister and its Group Companies may communicate with me about my order, using the contact information (postal address, email, phone, & sms text) that I have provided.

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