Direct to Patient Sample Requests | Nestlé Health Science

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Please do not use this form in a clinical emergency.

For Republic or Ireland, please use this sample request form

To speak to a member of our customer services team, please email uksamples@vitaflo.co.uk or call 0151 702 4936.

Find out what is included in our sample packs

If you are ordering PKU start for a newly diagnosed patient, please use the bridging stock option.

These samples are for...

Please select which disorder:

Please select your samples

Please select your samples

Long Chain Fatty Acid Oxidation Disorders

Drug Resistant Epilepsy (DRE)

Nutrition Support

Glycogen Storage Disease

Low Protein Foods

I want to order PKU explore or squeezie

This is necessary to ensure we are following IFSMP regulations.

PKU explore and squeezie

PKU cooler, air, express, sphere

I want to order MSUD explore

This is necessary to ensure we are following IFSMP regulations.

MSUD explore

MSUD cooler and express

I want to order HCU explore

This is necessary to ensure we are following IFSMP regulations.

HCU explore

HCU cooler and express

I want to order TYR explore

This is necessary to ensure we are following IFSMP regulations.

TYR explore

TYR cooler, express and sphere

I want to order MMA/PA explore

This is necessary to ensure we are following IFSMP regulations.

MMA/PA explore

I want to order GA explore

This is necessary to ensure we are following IFSMP regulations.

GA explore

Low Protein Foods

Flavourpac, FruitiVits and Basecal

Patient Name

Delivery Address

Postcode

Special delivery requests

Patient age

Delivery Telephone Number

Mobile number preferred.

Select your centre:

Healthcare Professional Place Of Work

Healthcare Professional Email Address

Additional Email Address

Healthcare Professional Contact Number

I agree to Vitaflo processing my personal data as set out in the Privacy Policy.

Vitaflo will supply the samples directly to the patient or (where the patient is under 13) the patient’s parent or guardian. By providing the patients’ name, address, date of birth and other information, and by ticking the box to acknowledge that you have read this advice, you confirm that you have obtained the patient’s consent (or the permission of the patient’s parent/guardian where relevant) to share the patient’s personal data with Vitaflo for the purpose of supplying product sample(s) to the patient.

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