Secure Sample Request

This secure sample request form is only for Healthcare Professionals only.

Please note when the form is submitted the data sent is held securely (128 bit encryption) for 24 hours whilst we process the request. It is then deleted from our server. All samples are dispatched within 24 hours of your request.

Name

Email*

Phone number

Please can you give us a contact number so we can pass this on the the recipient of the sample should they need to get in touch with you - Note we will only use this number for this purpose.

Recipients name

Please let us know who this sample is for, so we can be sure to direct it to the right place when it arrives at its destination.

Recipients Email

If you want us to email the recipient to tell them their samples are being posted, please add it below.

We do not keep their email or send marketing material.

Where would you like us to send your sample?*

Address line 1 Address Line 2 City County Postcode Country

What consistency do you require?

Which Slõ Drink would you like to try*

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.