Request a Gel Pack sample by completing the form below.

* Company Name:   Contact:   Address 1:   Address 2:   City:   Province or State :   Postal Code:   Telephone Number:   * E-mail Address:   Website:       * Validate Code:     Validate Code: gelpack

Please note that an email verification will be sent to confirm
that you are a medical professional or part of a medical facility.

Order your Gel Packs today! simply download the order form and fax it to
905-849-9996.

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