Brochure/Sample Request Form

HEALTH PROFESSIONALS ONLY:

Our sample set includes:

1 Babybellyband Original Maternity Belt
1 Groin Band Set for Compression Therapy
1 Set of Shoulder Straps
Educational Brochures*
Tear Off Notepads*

*Due to the overwhelming number of requests, we are now charging shipping and handling fees. Free Brochures and notepads can be requested at any time at no cost, see below.

Order Sample Set Click Here

Fill Out Form Below for FREE BROCHURE ONLY ORDER

We are pleased to provide Babybellyband free educational brochures to Health Professionals actively providing services in the field of Pelvic Floor Physical Therapy, Obstetrics/Gynecology, Midwifery, Doula or Pregnancy support, Childbirth Education, Urogynecology, Oncology, Lymphedema, or any other medical professional working with patients experiencing pelvic pain. Please fill out the below request form in full. Note: By submitting this form you agree to be automatically subscribed to our mailing list. You will be able to unsubscribe at any time.

Name*
First Last
Name of Business*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Website of Practice
Phone*
Quantity of Brochures*
How many brochures would you like to order?
If other, specify how many brochures here.
Number of Practice Locations*
How many location does your practice serve? We can send sample sets for each location if this is helpful.
If other, specify how many practice locations?
Where did you hear about Babybellyband Products?*
Any other comments or questions.