Complete the online form below to receive one free sample of Salonpas^® Pain Relief Patch Large 1ct.

Limit one sample per household. Duplicate requests will not be honored. Offer valid only in the contiguous United States (i.e. excluding Alaska and Hawaii), and while supplies last.

* Indicates a required field

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* First Name

* Last Name

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* Address Line 1

Address Line 2 — Leave blank if not applicable

* City

* State

* Zip Code

I would like to receive news and special offers from Salonpas (email is required)

* I am 18 years of age or older

* 1. Which of these describe your past experience with Salonpas Pain Relief Patches?

I’ve used a Salonpas Patch in the past year

I used a Salonpas Patch more than one year ago but not in the past year

I’ve used pain relief patches from other brands and have never tried a Salonpas Patch

I’ve never used any pain relief patches before

* 2. Please tell us how you learned about this offer (select all that apply):

Television

Salonpas Social Media or Website

Blogger

Other

* 3. How are you planning to use your sample of Salonpas Pain Relief Patch Large?

Back pain

Shoulder pain

Neck pain

Knee pain

Other body part pain

* 4. When did you first hear about Salonpas Pain Relief Patches?

I heard of Salonpas more than one year ago

I heard of Salonpas in the past year before seeing this free sample offer

I learned of Salonpas from seeing this free sample offer

I do not recall when I first heard of Salonpas

* 5. How do you treat body aches and pains?

I do not treat body aches and pains

I use only pain relief pills to treat body aches and pains

I use only creams/gels to treat body aches and pains

I use only patches to treat body aches and pains

I use both pills and topical treatments (creams/gels or patches)

I use other methods to treat body aches and pains

Please allow 6-8 weeks for delivery.

Complete the online form below to receive one free sample of Salonpas® Pain Relief Patch Large 1ct.

Complete the online form below to receive one free sample of Salonpas^® Pain Relief Patch Large 1ct.