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Direct-to-Patient Sample Service
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Your Practice or Department Details
(Please use a valid NHS email address)
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- Required.
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Practice or Department
Street Address
City
County
Postcode
First Name
Surname
Email Address
Contact Number
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Job Role
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- Required.
Admin/Other
Carehome Manager
Carehome Pharmacist
CEO/CFO
DAATs
Dietetic Assistant
Dietitian
Dietitian(Acute)
Dietitian(Community)
Dispensary Manager
Dispenser
GP
Head of Medicines Management/Optimisation
Lecturer in Dietetic Practice
LPC Chair
LPC Committee Member
LPC Treasurer
Medicines Management
Medicines Management Assistant
Medicines Management Projects Manager
Medicines Optimisation Technician
Nurse
Nurse Practitioner
Nurse Prescriber
Other
Pharmacist
Pharmacy Manager
Practice Based Pharmacist
Practice Manager
Prescribing Support Dietitian
Procurement
SALT
Tissue Viability Nurse
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I declare that I am a UK Healthcare Professional
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I am a UK Healthcare Professional
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Please select an AYMES Product for your patient
(Please note that Shakers are included in AYMES Shake, AYMES Shake Compact, AYMES Shake Smoothie and AYMES Shake Extra Sample Packs)
Required
- Required.
AYMES Shake
AYMES Complete
AYMES Savoury
AYMES Shake Extra
AYMES Shake Compact
AYMES ActaSolve Smoothie
AYMES ActaSolve Delight
AYMES 2.0 kCal
AYMES ActaGain 2.4 Complete Maxi
AYMES Creme
AYMES 250ml Shaker
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Patient Details
(By optionally adding in the recipients contact number, they will receive delivery updates)
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- Required.
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Name
Street Address
City
County
Postcode
Phone Number
Delivery Instructions for Driver (please don't add order requests to this field)
This is required
