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VITAFOL ULTRA-FIRSTSTEP
> REQUEST FREE SAMPLE Delivered to your home
IMPORTANT INFORMATION
> SAVINGS OFFER
> PATIENT BROCHURE
FOR HEALTHCARE PROVIDERS
> SAMPLE REQUEST FORM
> CONTACT
Free!
12-Day Sample
Offer
Welcome to the
first step
on the road to proper prenatal nutrition with VITAFOL
®
Please provide all information below
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
City
State
ZIP Code
Patient's info
Name
*
First
Last
Address
*
Street Address
*
Address Line 2
City
*
State
*
ZIP/Postal Code
*
At what stage are you in your pregnancy?
Trying
First Trimester
Second Trimester
Third Trimester
Prefer Not to Say
Email
*
Phone number
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 and updates by email from the makers of VITAFOL
®
ULTRA.
I understand and agree with the
privacy policy
of this website.
Please leave this field empty.
