Fresubin Sample Service ®

Fresubin ® Sample Service
Please tick the relevant box to ensure your patient receives the appropriate ONS sample pack for them.
Fresubin® 2kcal Drink
Fresubin® Energy SIP feeds
Vanilla
Apricot-Peach
Fruits of the Forest
Cappuccino
Neutral
Toffee
Cappuccino
Tropical Fruits
Vanilla
Banana
Chocolate
Strawberry
q
Fresubin® 5kcal SHOT
Fresubin® Crème
Lemon
Neutral
Vanilla
Wild Strawberry
Chocolate
Caramel
q
q
q
Fresubin® YOCrème
Fresubin® jucy
Apricot-Peach
Biscuit
Lemon
Raspberry
Apple
Blackcurrant
Orange
Pineapple
q
q
Fresubin® thickened Stage 1
Vanilla
Wild Strawberry
Fresubin® Powder Extra
q
Fresubin® thickened Stage 2
Vanilla
Wild Strawberry
Neutral
Strawberry
Vanilla
Chocolate
q
q
Health Care Professional Details
Patient Details (Delivery Address)
Name:
Name:
Position:
Address: (BLOCK CAPITALS)
Address: (BLOCK CAPITALS)
Postcode:
Postcode:
Email:
Mobile No:
Tel:
(For delivery confirmation purposes)
Please fax completed form to 01369 708861
ENTERAL NUTRITION
Fresenius Kabi Ltd, Cestrian Court, Eastgate Way,
Manor Park, Runcorn, Cheshire, WA7 1NT
Tel: 01928 533533 Fax: 01928 533520
www.fresenius-kabi.co.uk
Email: www.nutrition.service@fresenius-kabi.com
® is a registered trademark of Fresenius Kabi AG. Fresenius Kabi Ltd is an authorised user.
© Fresenius Kabi Ltd. September 2012
EN00843