Request Samples

Kate Farms is happy to provide samples to patients at the request of a doctor or dietitian.

If you are a health care professional requesting samples for yourself:
please submit the form below with your shipping information. 

If you are a health care professional requesting samples for a patient:
Please submit the form below with your contact information at the top, and the patient's shipping information in the bottom section. We prefer to communicate directly with the doctor or dietitian, and will not contact the patient unless you request us to do so.

 
Your Contact Information
Name *
Name
Select best description of your role
Product(s) You'd Like to Sample *
Recipient Shipping Information
To whom should we ship the samples? (No P.O. Boxes)
Additional Info