Request Samples

Thank you for your interest in Beach Pharmaceuticals. You may submit one request per product per quarter for each Health Care Professional.

Please click on the link below to download a PDF Sample Request Form.  Once the form is completed, you may fax it to: 813.839.4665 or email us at

Download Sample Request Form

This form should NOT be used to report Adverse Events. To report Adverse Events, please click here.

The information we collect from you will be used as provided in our Privacy Policy, including to respond to your request. By submitting this form, you understand that eligibility to receive samples is not guaranteed.


Beach Pharmaceuticals PillBeach Pharmaceuticals
3010 W DeLeon St
Tampa, FL 33609

(813) 839-6565 phone

(813) 839-4665 fax