Request sample

Vitaflo USA Sample Request

*Required fields

Welcome to our Sample Request form. The form should take just a few minutes to complete.

If you have any questions, please contact us at +1-888-848-2356 or email us. Our hours are Monday - Friday 9am - 5pm ET.

How'd you hear about us? (Select all that apply)
Advocacy Group
Social media
Email from Vitaflo
Healthcare Professional
Friend/Family
Internet search
Other

Sample Information

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Sample product limit reached

Do you need a shaker cup when appliable?
ו Important: We are unable to provide samples of Renastep temporarily. Current stock will be made available for patients who currently have prescriptions or are transitioning to these products. We apologize for this inconvenience.
Would you like to have a Virtual Taste Test with a Vitaflo team member*?
*RD approval is required.
Would you like to have a Virtual Taste Test with a Vitaflo team member?
Please specify
*RD approval is required.
What's your reason for requesting a Vitaflo sample? (Select all that apply)
What's your reason for requesting a Vitaflo sample? (Select all that apply)

Sample Shipping Information

*please note, we do not ship to P.O. Box Addresses

Medical Information

We ask for your Healthcare Professional information since our products are categorized by the FDA and will require authorization prior to shipping.

Authorization

Vitaflo seeks authorization for all samples by a Healthcare Professional prior to shipping.

Privacy Statement & Authorization to Share Information:
Your privacy is important to Vitaflo USA, LLC (Vitaflo). Personal information collected by Vitaflo may be shared with Vitaflo’s affiliates, agents and contractors as well as other outside organizations (including healthcare providers, health plans and other product and service providers) to help provide patients with reimbursement support, including benefit verification, prior authorization and other reimbursement services. Additionally, Vitaflo and its affiliates and agents may use this information to contact patients about Vitaflo and its products and services. By submitting this information, I agree that Vitaflo and the outside organizations with which Vitaflo shares this information may contact me at any of the telephone numbers, including cell phone numbers, or email addresses provided. Vitaflo will not sell or rent personal information to others.

Click here to review our Terms of Use.
×If you are having any issue with your form please send us a quick email at customerservice@vitaflousa.com or call us at 1-888-848-2356.

Privacy Statement & Authorization to Share Information:
Your privacy is important to Vitaflo USA, LLC (Vitaflo). Personal information collected by Vitaflo may be shared with Vitaflo’s affiliates, agents and contractors as well as other outside organizations (including healthcare providers, health plans and other product and service providers) to help provide patients with reimbursement support, including benefit verification, prior authorization and other reimbursement services. Additionally, Vitaflo and its affiliates and agents may use this information to contact patients about Vitaflo and its products and services. By submitting this information, I agree that Vitaflo and the outside organizations with which Vitaflo shares this information may contact me at any of the telephone numbers, including cell phone numbers, or email addresses provided. Vitaflo will not sell or rent personal information to others.