Republic Of Ireland Sample Requests

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Vitaflo Ireland have moved their sample form. To request a sample please visit the Vitaflo Ireland Sample form.

These samples are...

Please Select Your Samples:

If you are unable to process the sample as required, or would like supporting literature, please use the additional information area below to describe your request.

Low Protein Foods

Vitabite (7 x 25g)

Mini Crackers (15 x 40g)

ProZero Unflavoured (6 x 1 Litre)

ProZero Unflavoured (18 x 250ml)

Prozero

ProZero Unflavoured (6 x 1 Litre)

ProZero Unflavoured (18 x 250ml)

Nutrition Support:

Pro-Cal powder starter pack (8 x 15g sachets)

Pro-Cal shot starter pack (3 x 120ml bottles, 1 bottle of each flavour)

MCTprocal starter pack (12 x 16g sachets)

Fruitivits (10 x 6g sachets) (32SF00C00A10)

Supporting Literature

Pro-Cal shot handy hints leaflet for patients who require nutrition support

Pro-Cal shot handy hints leaflet for adult patients with kidney disease who require nutrition support

Pro-Cal shot handy hints leaflet for paediatric patients for require nutrition support

Pro-Cal powder handy hints leaflet for patients who require nutrition support

Fruitvits information tear off pad

Additional Information

Special delivery requests

Select your centre:

Only for Low Protein samples

Healthcare Professional Name

Place of Work

Patient name:

Department Name, Building & Floor Number

Delivery Address

Postcode

Patient age:

Delivery Telephone Number

Please note that any requests submitted without a delivery telephone number will not be accepted.

Healthcare Professional Name

Healthcare Professional Place of Work

Healthcare Professional 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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