Alfamino Junior Formula

Alfamino® Junior is a 100% amino acid based hypoallergenic formula for the dietary management of cow’s milk allergy. It is also suitable for children with multiple food allergies and malabsorptive conditions.

Alfamino® Junior STARTER PROGRAM

Alfamino® Junior Sample Request by Healthcare Professionals

To send a FREE case of Alfamino® Junior directly to a patient’s home, complete the required fields below and enter the PIN code provided by your Nestlé Health Science representative. A delivery tracking notice will be sent to the email inputted in the “Email” field. This can be either the email of the healthcare professional OR the patient.

Note that the program allows one sample case of Alfamino® Junior per patient address, but you can use the same code and email for multiple patients. If you require more than one sample for a patient, please contact your Nestlé Health Science representative.

Order Form

Name of Recommending Healthcare Professional:

Discharging Hospital (if available):

PIN:

Product:

Patient First Name:

Patient Last Name:

City:

Province (CA):

Address:

Apt., Suite, Unit (optional):

Postal Code:

Email:

Telephone Number:

Agreement

By ordering a sample case, you are confirming that the patient or caregiver is at the age majority in the province or territory where he/she lives. Samples are available for Canadian shipping addresses only. Limit of one (1) sample case per household.

I have read, understood and agree to the Terms & Conditions. By clicking submit, I understand that my information will be governed by Nestlé’s Privacy Policy.

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Order Form

Agreement