Supplement Order Form

Please fill out all required fields below:

Legal First and Last Name

Date of Birth

Phone Number

Date

QUANTITY and NAME of Supplement(s)

**Due to new shipping costs through Wholesaler, confirm shipping with Front Desk. **

Please give us 1-3 business days to confirm the order total.

Please Confirm Shipping Address If Order Is Ship To Home

(Please write PICK UP if you would prefer to pick up at the clinic)

Supplements exempt from Free Shipping are SBI Protect, Wobenzym, Curaphen, BPC-157, KVP, and TB4/FRAG.
Regenemax and some Seeking Health Products require an extra shipping fee.
We are unable to ship CBD products directly to patients home.

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