Request a Sample

If you are a Physician, complete and submit the sample request form
below and your local F&P sales representative will be in touch
with you regarding your request.

If you have an enquiry about our products, please provide the following information so a Fisher & Paykel Healthcare representative can contact you. For further details on how this information will be used, see below or go to our privacy statement.

Physician Details

First Name
Last Name

Practice Details

NPI Number
Address Line 1
Address Line 2
Postal Code

Request Details

Please enter the reason for your sample request

F&P Vitera Full Face Mask


F&P Eson 2 Nasal Mask


F&P Brevida Nasal Pillows Mask

Extra Small - Small
Medium - Large

Enter security code
 Security code
By submitting this form, you consent to Fisher & Paykel Healthcare storing your personal information to contact you about your enquiry. Your information will be collected and stored securely by Fisher & Paykel Healthcare Limited based in New Zealand and may be shared with the wider Fisher & Paykel Healthcare group as necessary to support your enquiry. We will not share, disclose or sell your information to third parties for marketing purposes. For full details on how we use and manage your personal information, how long we may retain this information for sales or marketing purposes, your rights to access, correct or delete your personal information, and how to contact us about your personal information, please see our privacy statement.