For medical professionals

For Medical Professional

Request pHemme™ Revive Samples

Samples are reserved for Doctors and Nurse Practioners only.
If you are a member of Physicians Online™, simply add pHemme™ Restore to your next sample order.
Click below to continue:

If you are a Nurse Practitioner, fill out the form below to order sample.

First Name

Last Name

Telephone Number

Practice Type

Medical Licence

Name of Clinic

Address

City

Postal Code

I would like to receive patient samples I would like to receive patient materials

I confirm that I am a licensed medical professional or an official representative of the medical practice.

Questions or Comments