Request a Sample

1Patient Information

2Metabolic Dietitian's Information

STEP 1 OF 2: PATIENT INFORMATION

Please complete the fields below with information appropriate to the patient who will utilize the samples.
Sample kits contain both TYR GoLike packets and bars.
Metabolic dietitians can order samples here.

Patient's First Name *

Patient's Last Name *

Email Address *

Patient's Date of Birth *

Relationship to the person for whom you are ordering samples* *

How did you hear about TYR GoLike?

SHIPPING INFORMATION

Note: We cannot ship to PO boxes or outside of the US.

Street Address *

City *

State *

ZIP Code *

Phone Number *

STEP 2 OF 2: METABOLIC DIETITIAN’S INFORMATION

Please complete the fields below. By including this information, you are confirming you have your metabolic dietitian’s permission to request the appropriate sample.

Metabolic Dietitian's Full Name *

Clinic Name *

Clinic City *

Clinic State *

Clinic ZIP Code *

Clinic Phone *

Dietitian's Email

Back

Thank you for requesting a sample of TYR GoLike®. We’ve received your request and will begin processing it shortly. Our team may reach out if we need any additional details to complete your order. Thank you again for your interest and for being part of the TYR community. - The Eton Cares Team

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