Product Sample Checkout

SAMPLE REQUEST

Thank you for your interest in trying Hollister products. To receive your sample pack, please provide the following information:

Customer Information

First Name:

Last Name:

Address: Street address only, no P.O. boxes accepted.

Address 2 (optional): Street address only, no P.O. boxes accepted.

City:

Country:

State/Province/Region:

Zip/Postal Code:

Phone Number (xxx) xxx-xxxx:

Email:

Are you:

Clinician/Healthcare Provider

Patient/EndUser

What product are you currently using:

Additional comments:

Physician Name

Please provide your prescribing Physician's name and phone number

Physician Name:

Physician Phone Number:

<hr /> <h5>Our Privacy Policy</h5>

Global Consumer Data Privacy Consent Statements

Order Request — must be checked to submit sample request

For the purposes of processing, fulfilling and communicating with me about the order that I am requesting, I consent to the processing of my personal identification, communication preferences, health information, product information, third-party information, transactional information and request details, where applicable, by Hollister, including by the Group Companies thereof (see link below). I understand that Hollister and its Group Companies may communicate with me about my order, using the contact information (postal address, email, phone and SMS text message) that I have provided.

Feedback

For the purpose of participating in Hollister’s feedback programmes, such as surveys, product or service evaluations and/or clinical trial activities, I consent to Hollister’s processing of my name, address, contact information (such as: telephone number and email address), age/birthday, gender and medical information, which consists of data related to my health and is necessary to ensure the suitability of my participation (such as mobility, type of surgery, product usage, skin conditions, lifestyle), where applicable, for this purpose. As used above, 'Hollister' refers to Hollister and its Group Companies (see link below).

Direct Marketing

For the purpose of receiving information about products, promotions and other direct marketing campaigns, I consent to the processing of my personal identification, communication preferences, health information and request details, where applicable, by Hollister, includes by the Group Companies thereof (see link below). I understand that Hollister and its Group Companies may communicate with me about these topics, using the contact information (postal address, email, phone and SMS text message) that I have provided.

Our Privacy Policy

Your consent is optional and you have the right to withdraw it at any time. To withdraw your consent or to make changes to your communication preferences, contact us at unsubscribe@Hollister.com. Such withdrawal only has future effect (i.e. the withdrawal of your consent has no effect on the lawfulness of the data processing and disclosures before the withdrawal was made).

For more details regarding Hollister and its Group Companies, please refer to our Group Companies Page. Please find further details regarding the processing of your personal data and your legal rights in our full Privacy Notice.

Yes, I understand.