Trans-anal Irrigation Samples

Do you have a current prescription for trans anal rectal irrigation from your doctor?*

Yes
No

Sorry

A doctor's prescription is required by federal (USA) law in order for MTG to ship TAI products to you. After you obtain a prescription, please return to this page.

Are these products for you?*

Yes
No

Gender*

Male
Female

Urinary tract infections in past year?*

None
1
2
More than 2

Cone size needed*

Adult
Pediatric

Who is your current medical supply company?*

Name*

First Last

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

We must call to confirm the shipment of your TAI products. A MTG representative will either call or email you in the near future. We are unable to send products unless we can verify information and determine which of our products best fits your needs

Email*

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Trans-anal Irrigation Sample Request

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