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Keto Epilepsy Hero kit

Request your free Keto Epilepsy Hero kit!

Keto Epilepsy Hero kits include a superhero cape, superhero mask, and instructions for sharing your Keto Epilepsy Hero’s story. Kits are available while supplies last.

For more information about the Keto Epilepsy Hero program, click here.

Fields marked with * are mandatory.

Your information

Parent/caregiver’s First Name*

Parent/caregiver’s Last Name*

Your Email Address*

Confirm Your Email*

Shipping Information (where should we send your cape?)

First Name*

Last Name*

Address Line 1*

Address Line 2

City*

State*

Zip*

Phone*

Country*

Please tell us a little more about your Keto Epilepsy Hero

Diagnosis for being on medical ketogenic diet*

Please specify*

Does your child use a medical ketogenic formula, such as KetoCal® or another brand? (This is for informational purposes only)*

Ketogenic Formula*

Please specify*

A few more questions

Are you interested in being contacted by Nutricia to further share information about your family’s journey with epilepsy and the medical ketogenic diet?*

Add me to KetoCal’s e-mailing list to receive medical ketogenic diet news, recipes, special offers, etc. (We promise not to spam you or sell your email address to other parties)*

Disclaimers

I understand capes are sized for children age 3 years old and up. Adult supervision required.

I confirm that my child is following a medical ketogenic diet for the management of epilepsy or another related condition and that he/she is under medical supervision with a healthcare professional*

By posting my child’s superhero photo publicly on my social media with the hashtag #ketoepilepsyhero, I give Nutricia North America and its affiliates the right and license to re-post such image, including my child’s name and/or likeness, on its social media pages including, but not limited to the Facebook, Instagram, YouTube and Twitter account for Nutricia North America and its associated brands, in perpetuity without additional compensation provided to me or my successors or assigns. I hereby certify that I am the parent or guardian of the child identified in this form, who is under the age of eighteen (18) years, and that I have the legal authority to grant the rights in this paragraph*

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KetoCal is a medical food for the dietary management of intractable epilepsy and is intended for use under medical supervision. Talk with your healthcare provider to determine if KetoCal is right for you.

KetoVie is a registered trademark of Ajinomoto Cambrooke, Inc and is not affiliated with Nutricia North America.

Please note that the purple superhero cape and mask displayed on our website and communications are for design purposes and the superhero cape and mask that you receive may look slightly different.

Keto Epilepsy Hero kits are available while supplies last.

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