Request Form

If you are a Health Professional and would like to request samples of any Pigeon product or a copy of the Hospital Price List, please complete the form below.

If you are a not a Health Professional but would like to request a sample, please do so via the ‘Customer Service’ tab.

Your Name (required)

Clinic/Hospital (required)

Your Email (required)

Phone (required)

Preferred Mailing Address (required)

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