To receive a sample request form for NEXLIZET or NEXLETOL, please provide your information below

After submitting your information, you will receive a Sample Request Form via fax, prepopulated with the details you provide here.

Please complete the form, including your sample quantity, and return via fax (1-833-864-8777) or email to EsperionDTP_PS@knipper.com.

All fields are required unless otherwise noted. Your data will not be saved or stored.


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You will be receiving a Sample Request Form via fax.

Please complete, date, and sign the form and return it by fax (1-833-864-8777) or email to EsperionDTP_PS@knipper.com.

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