Request samples

For prescribers only. Tell us what you're interested in and we'll deliver your samples to your clinic, free of charge.

About you

First name *

Last name *

Email *

Phone *

Professional info

License number *

License type *

Clinic / practice name *

Samples

Select all that apply. *

Acne sample formulationsHair loss sample formulationsMelasma sample formulationsRosacea sample formulations

Additional notes (optional)

Shipping address

We'll deliver your samples to this address, free of charge.

Attention / recipient (optional)

Street address *

Suite / unit / floor (optional)

City *

Province / territory *

Postal code *

Consent

I consent to PROCARE Pharmacy contacting me by email or phone about this sample request and related professional product information. I understand I can withdraw consent at any time by emailing info@donmillspharmacy.ca. *I am a licensed healthcare practitioner in good standing, authorized to receive drug samples, and this submission is my signed written request for the samples selected above. I confirm the samples will be used solely for professional evaluation in my practice and will not be sold or redistributed. *

PROCARE Pharmacy — DermInsight 2026