Medical Samples

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Medical Samples

If you are a sleep doctor or sleep center and need a Rematee sample, please complete this form.

Sleep Center / Company Name *

First Name *

Last Name *

Title *

Your Job Title / Position *

Office Street Address *

Street Address Line 2

City *

Zip / Postal Code *

Country *

Office Number *

Format: ###-###-####

What would you like us to send? *

Wholesale Information Kit (Please ONLY check this box if you are interested in having Rematee available for sale from within your clinic)

Sample Bumper Belt (size to be sent varies depending on stock. If you would like a specific size, please call us)

Patient Information Brochures (x50 units)

Required

Who is the Medical Director at your sleep center? *

How many OSA patients do you see monthly? *

How many beds are in your sleep center?

How did you hear about Rematee? *

Submit

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