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Order your LoFric samples here!

Thank you for your interest in the LoFric catheter. LoFric is a catheter brand that has been on the market for over 25 years and is the most clinically documented hydrophilic catheter proven to reduce the risk of UTIs and long-term complications. Please submit the form below to receive samples of the LoFric catheter. If you have any questions, contact us at 1-877-4-LOFRIC (1-877-456-3742).

Fields marked with * are required to complete the order.

Please note: you must use Internet Explorer v.6+ and have Javascript enabled to be able to use the form. Support for other browsers is coming soon.

Personal information:
First name (if child only provide caregiver´s details) *
Last name (if child only provide caregiver´s details) *
Address *
City *
State *
Zip *
Telephone *
E-mail *
I prefer to be contacted via e-mail Yes
I am a * Patient
Parent or caregiver
 
Please select product and size:
FR is the size - if you are unsure, please check with your doctor or nurse.

LoFric *   Length (in) *   FR *
 
Additional information:
Name of doctor that prescribes your catheters *
Doctor´s city and state *
Doctor´s phone number *
Who is your medical supplier?
Where did you hear about LoFric?
Please type additional requests, questions, and comments here