READ THIS FIRST

 

1. COMPLETE THIS FORM

2. FORM WILL BE REVIEWED BY A NURSE PRACTITIONER 

3. IF APPROVED, INVOICE WILL BE SENT

4. ONCE INVOICE IS PAID IN FULL, VITAMIN/SUPPLEMENT PRESCRIPTION WILL BE PLACED WITH PHARMACY 

5. MEDICATION WILL BE SHIPPED TO ADDRESS ON FILE IN 5-7 BUSINESS DAYS.