Sample Request Forms
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YUPELRI® (revefenacin) inhalation solution
YUPELRI Sample Request Form
If you’re a healthcare professional, you may be eligible to receive samples of YUPELRI. To make a request, download and complete the YUPELRI Sample Request form, then fax it to the attention of Viatris’ Sample Department at 304-285-6418.
Sample Request Form