Request a Sample

HR® Lubricating Jelly samples are only available to eligible medical professionals.

Name*
First Last
Email*
Phone*
Business / Organization Name*
Business / Organization Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reason for Interest*
- Medical Professional
- Sales Representative
- Government
Primary GPO / Distributor
Referral Source*
What lubricant are you currently using?
What procedures are you using lubricant for?
Choose Product(s) to Sample*
- HR® Lubricating Jelly 3g OneShot®
- HR® Lubricating Jelly 5g OneShot®
- HR® Lubricating Jelly 1.25oz. (36g) OneShot®
- HR® Lubricating Jelly 1.25 oz. (36g) OneShot® SafeWrap™
- HR® Lubricating Jelly 1.25 oz. (36g) 2X OneShot®
- HR® Lubricating Jelly 2oz. (56.5g) Flip-Top Tube
- HR® Lubricating Jelly 2X 2oz. (56.5g) Flip-Top Tube
- HR® Lubricating Jelly 4oz. (113g) Flip-Top Tube
- HR® Lubricating Jelly 10ml Pre-Filled Syringe
Additional Comments