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PKU Sample Request

Easy, Portable, PKU Formula from Vitaflo®
Vitaflo PKU products can help you or a loved one get the nutrition they need to keep them moving.

Backed by over 20 years of cutting-edge research. Vitaflo products meet the dietary requirements of a phe- or protein- restricted diet and come in a variety of formats that fit into your lifestyle.

Click here to request a sample

About Vitaflo
For over 20 years, Vitaflo has been at the forefront of development innovative specialized clinical nutrition products. Our dedicated experts have over 30 years' experience in producing specialized nutritional products. Working in partnership with world key opinion leaders and patients, Vitaflo's aim is to create products that combine the best of cutting edge research with the lifestyle demands of modern living, ensuring the most acceptable products are available for the patient.

Our product range for PKU

Request a Sample
  • Phenylketonuria (PKU) Sample Kit
  • Choose your products

  • Sample Information
  • Person Requesting Sample
  • Email
  • Email confirmation
  • First name (individual receiving product sample)
  • Last name (individual receiving product sample)
  • Patient Date of Birth (MM/DD/YYYY)
  • Comments or special requests
  • How did you hear about this program?

  • Shipping Information
    *please note, we do not ship to P.O. Box Addresses
  • Street address
  • Address line 2
  • City
  • State
  • Zip Code
  • Home Phone number

  • Medical Information
    We ask for your Healthcare Professional information since our products are categorized by the FDA and will require authorization prior to shipping.
  • First name
  • Last name
  • Healthcare Professionals Phone number
  • Is Patient currently attending clinic
  • In which state is your clinic?
  • Clinic Name
  • Medical condition
  • Protein prescription if known
  • How many grams of protein equivalent / day?
  • Current formula
  • How do you obtain your formula (e.g. DME, pharmacy, etc.)
  • If you are a Dietitian or Physician requesting a sample for your patient, please enter your RD or Physician license number
  • Vitaflo seeks authorization for all samples by a Healthcare Professional prior to shipping. I agree to sample authorization and accept the Terms of Use of this website. If you require any assistance, please call 888-848-2356 (Tick box)
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