Complete this form to receive a sample of ThickenUp® Clear stick packs.

ThickenUp® Clear is an instant food and drink thickening powder made with xanthan gum to provide swallowing support for people dysphagia and to be used under medical supervision. ThickenUp® Clear is not to be used in children under 3 years of age.

*Participant understands ThickenUp® Clear is intended to be used under medical supervision and should consult with the healthcare provider prior to use. Limit one (1) per household while supplies last. Product samples are for individual/patient use only and completion of the free sample form serves as confirmation that the recipient does not intend to sell the samples. Company reserves right to limit quantities. Eligibility conditioned upon the intended individual/patient of this free sample program and while supplies last. Program terms subject to change or cancellation at any time. Valid only in the U.S.; not available in Alaska or Hawaii. No medical insurer, including private insurers or any government healthcare program, may be billed for the sample product.