Complete the online form below to receive a FREE 1ct sample of Salonpas^® Lidocaine FLEX Patch.

This giveaway is for one free sample of SALONPAS FLEX patch while supplies last. It is open to legal residents of U.S. To receive the patch, you must fill in the form below. The offer is non-transferable, and no cash alternative is available. The offer may be canceled at any time, without prior notice. Use the product as directed. This offer is governed by the laws of New York.

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

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Prefix
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* First Name
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MI
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* Last Name
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Suffix
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* Address Line 1
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Address Line 2 — Leave blank if not applicable
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* City
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* State
Select StateAlabamaAlaska — Offer unavailable at this timeArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaii — Offer unavailable at this timeIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingPuerto Rico (US) — Offer unavailable at this time

* Zip Code
Enter your postal code. Required.

* 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

Which Salonpas products do you currently use or have used in the past?
(Select all that apply)

Salonpas^® Pain Relief Patch LARGE

Salonpas^® LIDOCAINE Pain Relieving Gel-Patch

Salonpas^® Arthritis Pain Relief Gel

Salonpas^® LIDOCAINE PLUS Pain Relieving Liquid

Salonpas^® LIDOCAINE PLUS Pain Relieving Cream

Salonpas^® Pain Relieving Patch

Salonpas^® Pain Relieving Patch LARGE

Salonpas^® Pain Relieving Gel-Patch HOT

Salonpas^® DEEP Relieving Gel

Salonpas^® JET SPRAY^®

Salonpas^® HOT

Salonpas^® Lidocaine FLEX

* 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

* How did you learn about this offer?
(Select all that apply)

Direct Mail

Salonpas Social Media or Website

Blogger

Other

* How are you planning to use your sample of Salonpas Lidocaine FLEX Patch?

Back pain

Shoulder pain

Neck pain

Knee pain

Other body part pain

I don’t know

* What is your age range?

18 — 24

25 — 34

35 — 44

45 — 54

55 — 64

65+

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I would like to receive news and additional special offers from Salonpas via postal mail.

* I am 18 years of age or older.

Disclaimer: By providing your name and other personal information above and clicking the “REQUEST FREE SAMPLE” button below, you authorize Salonpas and its agents to provide you with information, including promotional and product materials, regarding offers, services and programs, or other Salonpas products that may be of interest to you, and to contact you by postal mail, email, or telephone to discuss Salonpas products and obtain feedback (for market research purposes). For more information regarding Salonpas’ practices with respect to personal data, please visit https://us.hisamitsu/privacy-policy. The offer may be canceled without notice.

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Please allow 6-8 weeks for delivery.