Medical Professionals Request Form

Medical Professionals may order patient samples and information about our products for office-use. Simply fill out the form below. We do not automatically send out samples on a regular basis. Please reorder as needed. All the information you provide will be kept strictly confidential.

If you are not a medical professional and would like to sign-up for information, coupons and other offers, please click here.

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  • RepHresh Vaginal Gel – For your patients with vaginal pH and odor issues.
    RepHresh Vaginal Gel is clinically shown to maintain healthy vaginal pH and eliminate odor. Healthy pH can help reduce risk of vaginal issues. RepHresh Gel samples are available in a 1 applicator sample pack. Instructions and coupons are enclosed inside each sample pack.

  • RepHresh Pro-B Probiotic – For your patients who want to maintain their feminine health with just 1 capsule a day.
    RepHresh Pro-B is clinically shown to balance Yeast & Bacteria to maintain feminine health. 1 capsule per day, taken orally, provides urogenital strains of healthy probiotic lactobacillus clinically shown to colonize the vagina to help maintain vaginal flora in a normal range.* RepHresh Pro-B samples are available in a 7-Day Starter Pack. Instructions and coupons are enclosed inside each sample pack.

  • Replens Long-Lasting Vaginal Moisturizer - For your patients suffering from vaginal dryness
    Replens is a clinically tested, long-lasting moisturizer that helps replenish vaginal moisture and rejuvenate dry vaginal cells. Replens provides immediate and long-lasting results. Replens samples are available in a 1 applicator sample pack. Instructions and coupons are enclosed inside each sample pack.

  • Pre-Seed Fertility-Friendly Personal Lubricant - For use when trying to conceive
    Pre-Seed is clinically show to be "sperm safe". Pre-Seed mimics natural fertile fluids and allows swimming sperm to move freely. Provides Antioxidant Support and is pH balanced to match fertile cervical mucus and pH of sperm.

I would like to receive patient samples for all four products:
RepHresh Gel, RepHresh Pro-B, Replens and Pre-Seed.
  Or, if you only need to reorder samples of one or two items at this time, please check the box(es) below to indicate the samples you require.
RepHresh Vaginal Gel
RepHresh Pro-B Probiotic
Replens Long-Lasting Vaginal Moisturizer
Pre-Seed Fertility-Friendly Personal Lubricant
I would like Brochures and Coupons Only:
I would only like to receive brochures and coupons, no patient samples are needed at this time.
* I confirm I am a licensed medical professional or an official representative of the medical practice.
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Thank you for including Replens and RepHresh Brands as part of your options for quality patient care.