As seen in....

Customizable Tees for
Patients & Staff

Promote your practice with some fun!
T-shirts are customizable and available
in white or black, long sleeve or short
sleeve. Starting at $19.99. Please contact
us at cs@castcoverz.com or call
1(877) 633-4310
for more information.

Personalized Poster - SAMPLE

Option A: Standard Rack Card Holder w/ Rack Cards
Option B: 8.5" x 11" Brochure Holder with Business Cards

Medical Professional Inquiry Form

Dear Medical Professional,

Thank you for requesting more information about CastCoverZ! products. We help your patients feel better so they heal better. We encourage you to join the growing list of practices and hospitals stocking or referring CastCoverZ! products to their patients.

As a Medical Professional (Staff / Doctor / Hospital / Clinic), you can request information about:

Referral Brochures (discounts for your patients, traceable promo code)
Case Good Purchases (private label options available)

In addition, sign up for our Referralz! Program where you can earn credit towards case goods or American Express® or Staples® gift cards. Click here for more information about the Referralz! Program.

Doctor Name* (First / Last):

Contact Name* (First / Last):

Title*:

Organization*:

Email*:

Web Site:

Phone*:

Mailing Address*:

City*, State/Province*, Postal Code*:

Country*:

Size of Practice (patients/week):
For office use only. Information will not be shared with third parties.

0–50 51–100 101+

Do you currently sell any products at retail?:

No Yes

Organization Specialty*:
(pediatric ortho, sports medicine, surgical center, podiatry, etc.)

How Did You Hear About CastCoverZ!:
(if applicable, please enter promo code)

Information Requested*:
(Please select all that apply)

Case Good Purchase and/or Private Label
(a CCZ! representative will contact you to
identify your needs)

Product Sample (mailed)

Customizable "Set Straight" T-shirts

2 FREE Personalized Posters
(if available, enter promo code: )

Comments / Questions?:

Security Code*: