Ask your doctor to order you a sample today!

Interested in trying Extensive HA® or Alfamino® formula?

We are happy to provide free samples of Extensive HA® or Alfamino® formula for your little one to try, but the request for a sample must come from your doctor.

In order to let your doctor know you would like a sample, please fill out the following information (lines marked with a * are required):

Your Doctor's Information

If you don’t have your doctor’s email address, ask your doctor to go to to request a sample directly.

Your Information

Delivery Information

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Sample Request Terms and Conditions
Participant understands Extensive HA® and Alfamino® formulas are intended for use under medical supervision and should consult with their healthcare provider prior to use. Limit one sample request per household through this sample request program while supplies last. Product samples are for individual/patient use only and may not be resold. Company reserves right to limit quantities. Sample request program terms and conditions are subject to change or cancellation at any time. Valid only in the U.S.; not available in Alaska or Hawaii. No medical insurer, including private insurers or any government healthcare program, may be billed for the sample product.