Objective: To study the impact of geographic access to care on metabolic control and compliance in phenylketonuria (PKU).Study Design: Phenylalanine (Phe) levels and number of samples obtained were abstracted from a data base of 76 patients age 100 miles) sending significantly less samples.Conclusion: Geographic access to care does not impact control of Phe levels, but it does affect the number of monitoring samples sent to the clinic. Age groups of adolescents and young adults have a strong impact on both control of Phe levels and number of monitoring samples compared to clinic guidelines.