No Obligation Free Sample

Medical Professional Sample

If you are unsure which ClemensTM product is right for you or for your loved one, request a FREE sample by completing the form below.

Institution name*

Contact person*

Phone number

Are you a medical professional or do you run a medical institution? Contact us to run a Free Patient Trial at your institution.

Street Address

Area

Region

Postal Code

Is the sample for you or a loved one? If for a loved one are they in a...

1. Are you currently experiencing incontinence

Yes No

2. Do you know what level of incontinence you are experiencing? Light, Moderate, Heavy

Yes No

3. Are you currently using any incontinence products? Yes – Pad, pants, slips/diapers

Yes No

4. What is your waist size/pants size?

What product do you wish to sample

Please select your size

Need help choosing the right product?