Pamela's Sample Request Form for Dietitians

Please read the directions carefully, so that we can be sure to receive your request and support your efforts.

This form was created specifically for Dietitians, Doctors and others who assist those with their wheat-free and gluten-diets. Our hope is that we can help people stay on their gluten-free diet and stay healthy. We believe that if everyone was handed a Pamela's Products Cookie while they learned about their new dietary restrictions, there would be a lot less stress in the process.

Please fill out this form if you would like to have samples in your office for your newly diagnosed patients.

If you are interested in learning more about a specific product of ours please go to our Products Section. If you have a question for us that does not have to do with a sample request, please fill out our Ask Pamela's form. If you are not a dietitian, doctor or other related professional, and would like samples for your support group or community group, please fill out our Donation Request Form. We pride ourselves on excellent customer service and hope that we are able to support your needs.

CAUTION: Samples are for Registered Dietitian ONLY. We do not offer free samples to the general public.

Your Name*:

The name of your practice or organization*:

Please tell us a little about your practice and patients*:

Shipping Address:
Is this shipping to a home  or a business

Ship to (person or company name)*:

Name of person to receive shipment:

Street Address Line 1*:

Street Address Line 2:

City, ST, Zip (We can only ship within the USA)*:

Phone number, please include area code first*:

Promotion Code (if applicable):

Your Email*:

Confirm your email*:

*Required fields.

We need your email address so that we can respond to your request. We respect privacy and do not gather or sell email addresses. For more about the Pamela's Products privacy policy please read our Privacy Policy Statement. If you do not hear from us within two weeks, please re-submit your request. We apologize for any technical errors that could hinder your request, and will do our best to keep those to a minimum. However, we are not responsible for requests that were not delivered.

This form in no way constitutes our agreement or contract by Pamela's Products. All donations will be confirmed prior to shipping. If you do not receive a confirmation from us within two weeks, please resubmit. Resubmitting does not constitute an agreement from us.

DO NOT submit if you are not a dietitian We do not offer samples to the general public.