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

Tell us about yourself: I am a...

Your date of birth

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

Patient information
Patient's date of birth
How'd you hear about us? (Select all that apply)
Please Specify
Sample Information
Choose your products

Choose your product

Comments or special requests
Would you like to have a Virtual Taste Test with a Vitaflo team member?
Please confirm

Sample Information

What's your reason for requesting a Vitaflo sample? (Select all that apply)
Sample Shipping Information
Address
*please note, we do not ship to P.O. Box Addresses
Healthcare Professional 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.

Issue info

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.