If you are a practicing clinician licensed to prescribe medical devices in your state, please complete the following information and we will mail you a free restiffic sample or restiffic literature, depending on your selection.

Choose a contact method:

Name*

NPI*

Practice Name*

Street Address*

City*

State*

Zip*

Email*

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You can expect your restiffic to arrive in the mail in 1-2 weeks.

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