Register for our Facility Sampling Program

If you are a healthcare professional serving patients in a hospital, nursing home, or other non-home setting, register below to request samples of Thick-It® brand products for your facility.

Note: If you treat patients in a home care or out-patient setting, register for our ProCare Sampling Program here.

First Name*
Last Name*
Job Title*
Facility Name*
Email*
Phone*
Address*
Street Address City State ZIP Code

This offer is valid in the U.S. only.
I am a*
If you answered "Other," please specify
Please identify your foodservice distributor:*
If you answered "Other," please specify
Facility Type*
If you answered "Other," please specify
Number of Beds*
Which dry or ready-to-use thickened products are you currently using?
How did you hear about us?*
If you answered "Other," please specify
Please enter your code:
What kind of patients do you see?*
If you answered "Other," please specify
What age are your patients?*
What product are you interested in and why?
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