Patient Connect GP

Where would you like the requested items sent?*

Please send the samples to meSamples will be sent to your chosen address to distribute to patients.
Please send samples directly to the patientSamples will be sent directly to your patient. Patient Connect will allow your patient to provide you with their feedback.

Please select product(s)

Please select products*

ProSource/ProSource Plus
ProSource Jelly
ProSource TF
ProSource TF ENFit
ProSource TF Plant
HyFIBER
ProSource 20

Please note: ProSource Liquid and ProSource Plus share identical flavours. We will send samples of ProSource Plus, unless specifically requested otherwise in the "Additional requests" box below.

Please note: ProSource 20 has not yet been submitted for ACBS approval.

Please select literature

Data card

Please include a copy for each of my chosen products

Patient Information leaflet

Please include a copy for each of my chosen products

Patient Information leaflet

Please include a copy for each of my chosen products
Please send a digital version(s) to my patient

Patient's email address

The patient's email address will not retained, used for any marketing or promotional purposes and will not be passed to any third parties.

Supporting Food Fortification Using ProSource booklet

Please include a copy

Managing Constipation booklet

Please include a guide for adults
Please include a guide for parents
Not required

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UNUSED - Supporting Food Fortification Using ProSource booklet

Please include a copy

This field is hidden when viewing the form

UNUSED - Supporting Food Fortification Using ProSource booklet

Please include a copy

This field is hidden when viewing the form

UNUSED - Supporting Food Fortification Using ProSource booklet

Please include a copy

Please list any additional literature you would like to receive printed copies of

(see our Resource Centre for additional literature)

Request a patientsample pack

Receive patient feedback

Please select product(s)

Please select literature

Recipient address

Patient address

Address breaker

Additional requests?

Request a patientsample pack

Receive patient feedback

Please select product(s)

Please select literature

Recipient address

Patient address

Address breaker

Additional requests?

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