Free Samples for Dietitians -Pediatrics Professional Samples

Request an Orgain Healthcare Ambassador Account

We're committed to supporting our Ambassadors with samples, coupons, special offers, resources, and continuing education that enable them to make a positive impact in the lives of their patients or clients.

If you are a credentialed healthcare professional providing direct patient care at a healthcare practice or facility, and are approved as a Healthcare Ambassador, you will receive:

Orgain Ambassador Welcome Kit

Access to Orgain Ambassador Sampling Portal

Personalized Ambassador Support

Access to Orgain Healthcare App

Professional Education & Resources

Access to Private Healthcare Professional Facebook Forum

Become an Ambassador In 3 Easy Steps:

Step 1

Complete and submit the Ambassador Account Request form below.

Step 2

Check your email inbox for an account activation email from Orgain Healthcare. (usually sent within 48-72 hours)

Step 3

Click the link in the account activation email, set your password, and log on to the Ambassador Sampling Portal.

**Please do not submit the form below more than once. Duplicate requests will not be honored**

Contact Information

Are You A Healthcare Professional?

Please provide your name, job title and email address here, and complete the remainder of the form with the information of the healthcare professional for whom you are submitting the request.

Your Name

Your Email

Your Job Title

Complete the fields below with information about the healthcare professional.

First Name

Last Name

Work Email

If you prefer to not use your work email for your ambassador account, you may provide a personal email below.

Personal Email (optional)

Mobile Phone Number

I'd like to receive text message notifications from Orgain Healthcare (e.g. order updates, tracking info, webinar reminders etc).

By selecting the checkbox and clicking "Submit Request" at the bottom of this form, I consent to receive recurring marketing text messages at the number provided, including messages sent by auto-dialer. I understand that consent is not a condition of any purchase, and I can withdraw my consent at any time by replying STOP. Message and data rates may apply. Message frequency varies. I agree to the Terms of Service & Privacy Policy, which includes Orgain's Notice of Financial Incentive.

Professional Information

Professional Credentials

License / Registration Number

Job Title

Please select how frequently you recommend meal replacement / high protein products (shakes, powders or bars) to patients or clients.

Recommendation Frequency

Choose Specilization

Facility Information

Please provide the following information for the primary facility or practice location where you see patients or clients.

Practice / Facility Name

Practice Website

I do not have a practice website

What Is Your Facility Type?

Facility Address

Please provide a physical address for your facility or practice that includes suite and/or floor number, if applicable. We're sorry, we're unable to ship samples outside the continental United States or to PO Boxes. While you are required to enter your facility address for verification purposes, you may select to have your Ambassador Welcome Kit shipped to your home or alternate address (that option is below).

Street Address

Suite / Unit (optional)

City

State

Zip

Shipping Information

Ship Welcome Kit To Facility Address.

Ship Welcome Kit To An Alternate Address.

Please provide an alternate shipping address that includes suite and/or floor number, if applicable. We're sorry, we're unable to ship samples outside the continental United States or to PO Boxes.

Company (optional)

Street Address

Suite / Unit (optional)

City

State

Zip

Additional Information

Please share why you want to be an Orgain Healthcare Ambassador and how you'll utilize complimentary Orgain samples. (optional)

I agree to the and Orgain Healthcare Sample Program

Free Samples for Dietitians -Pediatrics Professional Samples

Request an Orgain Healthcare Ambassador Account

Become an Ambassador In 3 Easy Steps:

This site is for healthcare professionals only