Request Samples - Applied Nutrition Corp.

For more information or product samples, fill out the form below and submit.
Be sure to include your complete mailing address, phone number and email.

*Required field

	Clinic/Dietitian Affiliation: Requested By: *Relation:


	*Name of Person with Metabolic Disorder:
	*Disorder:
	*D.O.B:	- -
	If Minor, Parent or Caregiver:
	*Street Address (No P.O. Boxes):
	*City:
	*State:	*Zip:
	*Country:	USA CANADA
	*Phone:	- - ext.
	*E-mail:
	*Current Formula:
	Amount Per Day:	grams protein equivalent
	Comments:

Select products you would like to recieve samples of:

PhenylAde products are intended for individuals receiving active, ongoing
medical supervision for the dietary management of Phenylketonuria.

25g of Protein Equivalent per 100g of Powder
FLAX & FIBER to Support a Healthy Heart
Balanced Nutrition for a healthy body. Excellent 4:1 ratio of Omega-6 to Omega-3
fatty acids and the only PKU formula with soluble fiber.
4 - 1 lb. Cans per Case • 16 - 40g Pouches per Case
Chocolate flavored
Vanilla flavored
Orange Creme flavored
Strawberry flavored

40g of Protein Equivalent per 100g of Powder
Low Fat • High Protein
PhenylAde40 is the first PKU product, fortified with vitamins and minerals, to be
packaged in economical, "go anywhere," single-serving pouches.
20 - 25g Pouches per Case
Unflavored
Citrus flavored

60g of Protein Equivalent per 100g of Powder
Fat Free • Low Calorie • High Protein
PhenylAde60 is a Fat Free, High-Protein, Phenylalanine-free PKU formula with vitamins and minerals.
4 - 1 lb. Cans per Case
Vanilla flavored

80g of Protein Equivalent per 100g of Powder
Protein Fortify Your Foods & Drinks
A phenylalanine-free medical food powder, that allows you to protein fortify low protein
food and beverages. Amino Acid Blend can also be mixed into PKU formula.
4 - 1lb. Cans per Case | 10 - 13g Pouches per Case
Amino Acid Blend unflavored
MTE Amino Acid Blend unflavored

10g of Protein Equivalent per Bar
Great Taste and Convenience on the Go
A PKU protein source in a medical food bar. Each bar contains 13g of amino acids,
which supplies a full 10g of protein equivalent.
12 Individually Wrapped Bars per Case
Chocolate flavored
Chocolate flavored Crispy*
White Chocolate flavored
*Crisp rice adds a small amount of protein including 8mg of Phenylalanine per bar.

Complex MSUD products are intended for individuals receiving active, ongoing
medical supervision for the dietary management of Maple Syrup Urine Disease.

Drink Mix

25g of Protein Equivalent per 100g of Powder
An isoleucine, leucine, and valine free medical food powder complete with
vitamins and minerals, in a traditional flavored drink mix..
4 - 1 lb. Cans per Case
Vanilla flavored

Amino Acid Blend

80g of Protein Equivalent per 100g of Powder
An isoleucine, leucine, and valine free medical food powder which allows people to
protein fortify beverages, formula and foods that the Amino Acid Blend is added to.
4 - 1 lb. Cans per Case
Amino Acid Blend unflavored

Amino Acid Bar

10g of Protein Equivalent per Bar
An isoleucine, leucine, and valine free protein source in a medical food bar.
Each bar contains 13g of Amino Acids which supplies a full 10g of Protein Equivalent.
12 Individually Wrapped Bars per Case
Chocolate flavored