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Request Samples

Direct to Patient Samples:

  • Samples are provided for tolerance trials only. Products should be tube fed. Oral nutrition supplements may not be requested unless there is a tolerance concern.
  • Delivery to patient may take approximately 5-7 business days once the request is processed.
  • Samples are limited to 1 order per patient.
  • Please be sure to double check the patient's mailing address.
  • By submitting your patient’s information and ordering samples, you are certifying that you have determined that this product is medically appropriate for your patient to sample, that you have explained this to your patient, and that you have obtained your patient’s consent to have samples of our products shipped directly to their home address.

STEP 1/3

Select product

(limit: 1 product)

PRODUCT

STEP 2/3

Patient’s Information

FULL NAME

ADDRESS

STEP 3/3

Physician’s Information

OTHER INFORMATION

LICENSE VERIFICATION

CDR Number may only be used for Healthcare Professionals in AZ, CA, CO, CT, IN, MI, NJ, and VA. For all other states, please provide your NPI Number or State License Number to avoid your order being rejected.

The name and address associated with your NPI Number or State License Number must match the name and address you provided in Step 1.

Request Sample