Enhancing Lives Together

Vitaflo Sample Request Form

Sample Requests

Product samples can be requested by Health Care Professionals only.


Hospital Address:

Building 30, 2 Park Road, Grafton





All hospital deliveries will be via loading dock.


New Zealand

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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Select Your Samples

If you require more than one of a product sample, please specify in the additional requirements box at the bottom of the form

Select your samples

Please note: Minimum order of 10 sample packs. Please select desired quantity below.

Phenylketonuria (PKU):
Maple Syrup Urine Disease (MSUD):
Homocystinuria (HCU):
Tyrosinaemia (TYR)
Glutaric Aciduria Type 1 (GA1) / Pyridoxine Dependent Epilepsy (PDE):
Methylmalonic acidaemia (MMA) and Propionic acidaemia (PA):
Urea Cycle Disorders (UCD)
Support Range
Glycogen Storage Disease
Fat Metabolism / Ketogenic
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

**To avoid submitting multiple orders, please only press the SUBMIT button once. A confirmation email will be sent to confirm your request. (If you cannot see this e-mail please check your junk folder)**