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SJP samples are available to prescribers. If you are a licensed prescriber, please complete the form below and we will email or fax you a sample request form. Licensed numbers will be verified prior to shipping.

Physician Name*:
State License Number*:
Address:
City:
State:
Zip Code:
Phone Number:
Fax Number:
Email Address*:
Questions and Comments:
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Urology: UTA Caps  Cardiovascular: Cardiotek-RX