Cubcath®ISC - Sample Request Form - Great Bear Healthcare

Request a sample

To request a sample of any of our Prescription items, please complete the below form.

*Required field
I am a:
Title*
First name*
Surname*
Address*
City / Town
Postcode*
Email*
Phone*
Where Do You Usually Get Your Supplies?*
If other, please specify
Why are you requesting a sample?*
If other, please specify
Your order
Product 1*
Product 2
Product 3
Product 4
If you require samples from more than one product range, please Freephone 0800 055 6270 or email marketing@gbhl.co.uk
How did you hear of Great Bear?
If other, please tell us how you heard of Great Bear:
Additional Information
Acknowledgement*
- Please check box to acknowledge that you have read and accept Great Bear Healthcare’s Privacy policy
Would you like us to send you product tips and advice straight to your inbox?*
- Yes, please!
- No, thanks.
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