Thank you for visiting the
Healthcare Professionals Section.
Please complete the fields below.
To thank you for your time, your samples will be
shipped as requested.*
Your First Name
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Organization/Company
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Address 2
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What is your Specialty?
Please Select
Dietitian
Endocrinology and Metabolism
Family Medicine
General Practice
Geriatric Medicine (Family Practice)
Geriatric Medicine (Internal Medicine)
Gynecology
Internal Medicine
Medical Oncology
Nurse Practitioner
Nursing
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Obstetrics and Gynecology
Orthopedic Surgery
Pharmacist
PharmD
Physician Assistant
Reproductive Endocrinology
Rheumatology
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Other Specialty:
Sample Preference
*:
Citracal Maximum - Quantity Two
Citracal Petites / Citracal Maximum
Bone Density Builder / Citracal Maximum
*We cannot assure your top preference will be available at the time of fulfillment. However, we will make every attempt to ship your selected choice.
On average, how often do you recommend calcium
supplements to your patients each week?
Please Select
Under 10 times per week
10-19 times per week
20-29 times per week
30-39 times per week
40-49 times per week
50 times per week or more
Which of the following considerations would
influence your decision on which calcium
supplement to recommend?
(Check all that apply)
Contains 1000mg of calcium per daily dose
Contains 1200mg of calcium per daily dose
Has Carbonate as the form of calcium
Has Citrate as the form of calcium
Comes in a form other than tablet (chewable/liquid)
Contains Magnesium
Contains Vitamin D
Sends samples to my office
Can be taken with or without food
Does not cause GI side effects
Pill size
Other (Please specify)
DEA#
License#
NPI#
DEA# or License# or NPI#
I confirm that I am a United States healthcare professional.
What brand(s) of Calcium supplements have you
recommended in the past month?
(Check all that apply)
Citracal
Os-Cal
Caltrate
TUMS
VIACTIV
Store Brand
I do not recommend a specific brand
A brand not listed here (please specify)
How did you hear about this professional
sample site?
Direct Mail
Sales Representative
Email from Citracalprofessional.com
Healthy Advice Network
Journal Advertisement
Television Advertisement
Reclast Patient Kit
Convention(s)
Internet Search
Other (Please specify)
Reclast is a trademark of Novartis, Os-Cal is a trademark of GlaxoSmithKline,
Caltrate is a trademark of Wyeth, VIACTIV is a trademark of McNeil Nutrition’s,
TUMS is a trademark of GlaxoSmithKline.
Citracal® Professional Sample Request
