Brain Care II and Clear Mind & Energy Ordering.
Due to Covid-19, Amazon has not allowed us to restock our products therefore we are making it available to you here. If you are an established patient please call the office at 818-990-1166 and speak with Candice.
 
 

TRI-PAK Information and Instructions (Open)

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Placing an Order  (NON-PATIENTS):  Please use this form below to place your order. It is transmitted securely to the office for processing.  

Purchase Order-Non-Patients
First name:
 * required
Last name:
 * required
Email address:
Phone:
Mailing address1:
Apt/Suite:
City/State:
Zip Code:
Billing Information
Products:
Products:
Credit Card#:
 * required
Expiration:
 * required
Card Code:
 * required
Card Zip Code:
 * required
I authorize this charge:
I agree to this charge.
Signature:
 * required
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