Disposable Pad Samples Order Form

Independence Australia offers customers who have new or recently changed continence requirements to access samples of disposable pads through our Sample Program.

This allows customers, once their needs are determined, to trial a few products to find the one that is most comfortable and suitable to their needs.

  Customers can select and order samples via the online Continence Selection Tool  Click Here

Alternatively, below is a Sample Product Order Form that can be completed and emailed back to Independence Australia for processing.

  Sample orders are restricted to a maximum of 3 types of products.  Any orders that exceed this will not be processed 

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