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Vitafol Ultra-FirstStep
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Take your first step on the path to proper prenatal nutrition by trying 12-days of Vitafol Ultra-FirstStep!
How did you learn about the VITAFOL ULTRA-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 that the VITAFOL ULTRA-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® ULTRA.
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I understand and agree with the
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