Sample Release Order Form

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    Contact Information

    Practice Information

    * Number of first time newborn visits seen per

    Order Information

    Order Type

    NewRenew
    Vitamin D Baby Ddrops® 400 IU Samples (15 dose bottle) 0-12 monthsDdrops® Booster 600 IU Samples (15 dose bottle) > 1 year
    Resources for you & your patients Vitamin D Brochures English with couponVitamin D Brochures Spanish with couponVitamin D for Children - Booster Brochures EnglishThinkmist DHA Brochures EnglishBrochure Holder
    I consent to privacy terms

    * I AGREE, I have read and agree to the privacy policy and terms on the Ddrops website prior to submitting this sample request form.

    I consent to CASL

    * By checking the box and submitting this form I consent to receiving informational, promotional and other marketing material from Ddrops Company at the facsimile number, telephone number(s) and email address(es) provided above on an ongoing basis unless and until I withdraw my consent. The contact information I have provided is my contact information as an individual healthcare provider, and is not that of an emergency line, or healthcare facility.

    You have the option of modifying or discontinuing the samples program and/or the marketing promotions program at any time. You may contact Ddrops Company at healthcare@vitaminddrops.com or 1-844-433-7677 or by mail at 126 Trowers Road, Woodbridge, Ontario, Canada, L4L 5Z4.