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Sample Request Form
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Take your first step on the path to proper prenatal nutrition by trying
VITAFOL ULTRA-FirstStep
or
VITAFOL GUMMIES-FirstStep!
Yes, I would like a free sample of VITAFOL ULTRA-FirstStep or VITAFOL Gummies-FirstStep.*
(Please note, there is no cost associated with free sample.)
Which product would you like to try?
*
VITAFOL ULTRA-FirstStep
Vitafol Gummies-FirstStep
How did you learn about the VITAFOL ULTRA-FirstStep/VITAFOL Gummies-FirstStep sample offer?*
How did you learn about the VITAFOL ULTRA-FirstStep™ sample offer?
*
Visit to my doctor's office
Phone call to my doctor's office
From a friend
Online Search
Other
Please tell us your doctor's name and practice location.
Doctor's Name:
*
First
Last
Practice Name
Address:
*
Street Address*
City*
State / Province / Region*
ZIP / Postal Code**
Patient’s Info
Name
*
First
Last
Address*
*
Street Address*
Address Line 2
City*
State / Province / Region*
ZIP / Postal Code*
At what stage are you in your pregnancy?*
At what stage are you in your pregnancy?*
*
Trying
First Trimester
Second Trimester
Third Trimester
Prefer Not to Say
Contact*:
Email
*
Phone Number
*
I understand that the VITAFOL ULTRA-FirstStep™
*
I understand the VITAFOL ULTRA-FirstStep™ sample or the VITAFOL Gummies-FirstStep™ sample is a one-time free offer, including shipping, that is being sent at my request, and that my personal information may only be shared with the parties responsible for fulfilling this request.*
I agree to receive important nutritional information
I agree to receive important nutritional information and updates by email from the makers of VITAFOL®.
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*
I understand and agree with the
privacy policy
of this website.*
THANK YOU!
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