K.Vita Sample Requests | Nestlé Health Science

Request a Sample

Request your samples by completing the form below. Your request will be shared with your dietitian/clinician for them to approve and then your samples will be sent out for you to try.

K.Vita is a food for special medial purpose for the dietary management of drug resistant epilepsy. Not suitable as a sole source of nutrition. To be used under medical supervision.

I confirm that I am a patient aged 18 or above, or I am the parent/carer of a patient.

I confirm that I have drug resistant epilepsy or glut 1 deficiency syndrome or I am the parent/carer of someone who has drug resistant epilepsy and glut 1 deficiency syndrome.

I confirm that I am under the medical supervision of a specialist neurology or epilepsy healthcare professional or I am the parent/carer of someone under the medical supervision of a specialist neurology or epilepsy healthcare professional.

First Name

Last Name

Delivery Address

Postcode

Special delivery requests

Delivery Telephone Number

Mobile number preferred.

I would like a sample of K.Vita

Select your centre:

Healthcare Professional Email Address

Healthcare Professional Contact Number

By ticking this box I confirm that:

I am a resident of the UK and I am a patient aged 18 years or the parent/carer/guardian of a patient.
I expressly agree to share my personal data or that of my child, as applicable, including special category data, i.e. data concerning my health/my child’s health contained and submitted in this sample request form, with Vitaflo (International) Limited (Vitaflo), its representatives and other third parties (e.g. Vitaflo’s courier) as reasonably required in order to use and process my personal data or that of my child, as applicable, including special category data, for the following purposes (the Purpose):
contacting my/my child’s dietitian (or other healthcare professional as detailed in this form) to obtain their approval to my use/to my child’s use of the Vitaflo product samples I have requested;
shipping the samples to the postal address I have provided; and
contacting and communicating with me in connection with my sample request and shipment of the samples.
I understand and expressly agree that Vitaflo, its representatives and third parties will use my personal data or that of my child, including special category data only for the Purpose and will not use or process any of my personal data and/or that of my child, including special category data, for any other purpose. I understand that after my personal data or that of my child is no longer required, my personal data or that of my child will be permanently deleted.

If you are looking for more information on how Vitaflo processes your personal data, or on Vitaflo’s approach to data security, data retention and lawful processing bases, you can access our privacy policy.

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