Request your XPhe minis protein substitute samples – Republic of Ireland Only Patient's Full Name (required) Your Email (required) Telephone (required) Address Line 1 (required) Address Line 2 (required) Town (required) Post Code (required) IMD Type (required) Phenylketonuria (PKU) XPhe minis Protein Substitute Samples Required: --- (For patients with PKU and HyperPhe only / suitable from 7 years of age) XPhe minis Dietician Full Name: (required) Dietician Full Hospital Name: (required) I consent for Firstplay to contact me via: EmailTelephoneOpt Out I consent for Firstplay to contact me about my sample request: YesNo By submitting this enquiry I consent for Firstplay to share my personal information with Biofact Pharma Read our Samples Policy Read our Privacy Policy {{#message}}{{{message}}}{{/message}}{{^message}}Your submission failed. The server responded with {{status_text}} (code {{status_code}}). Please contact the developer of this form processor to improve this message. Learn more{{/message}}{{#message}}{{{message}}}{{/message}}{{^message}}It appears your submission was successful. Even though the server responded OK, it is possible the submission was not processed. Please contact the developer of this form processor to improve this message. Learn more{{/message}}Submitting…