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

* How did you learn about this offer?
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* How are you planning to use your sample of Salonpas Pain Relief Patch Large?

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

* How do you treat body aches and pains?

Which pain relief product brands have you used before?
(Select all that apply)

What form of pain relief products do you use?
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What types of pain do you suffer from?
(Select all that apply)

If you use Salonpas products, which products do you use?
(Select all that apply)

What is your age range?

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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

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Please allow 6-8 weeks for delivery.