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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.

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Enter your first name. Required.

Enter your middle initial.

Enter your last name. Required.


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Enter your address line two. Leave blank if not applicable.

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

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

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

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

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

Please allow 6-8 weeks for delivery.