This is for established patients Only.  To help automate and expidite your ordering of refills for your protocol, please use the form below:
Millennium-TBI Protocol Supplements
1. UltraNutrient:# 360 ($120)	Purchase None One Two
2. Pregnenolone #180 ($55)	Purchase None One (1) Two (2)
3. DHEA # 180:($35)	Purchase None One (1) Two (2)
4. Ultra B w/PQQ #60 :($65)	Purchase None One (1) Two (2)`
5. Cognitive Aminos #120:($40)	Purchase None One (1) Two (2)
6. Vitamin D 10K #120:($40)	Purchase None One (1) Two (2)
7. Vitamin D 5K #120:($35)	Purchase None One (1) Two (2)
8. N-Acetyl Cysteine #240:($75)	Purchase None One (1) Two (2)
9. Synergic E # 240:($75)	Purchase None One (1) Two (2)
10. ChromeMate GTF # 180:($35)	Purchase None One (1) Two (2)
11. Zinc Citrate #120:($20)	Purchase None One (1) Two (2) Three (3)
12. Chlomiphene 50mg #30:($75)	Purchase Rx needed. None One (1) Two (2)
13. Thyroid 32.5mg, #100:($45)	Purchase Rx needed. None One (1) Two (2)
14. Thyroid 48.5mg, #100:($45)	Purchase requires Rx. None One (1) Two (2)
15. Thyroid 65mg, #100:($45)	Purchase requires Rx. None One (1) Two (2)
16. Clear Mind & Energy: 4oz. ($36)	Purchase None One (1) Two (2) Three (3)
17. DynaTropin #1:($80)	Purchase. None One (1) Two (2)
18. DynaTropin #3 :($200)	Purchase. None One (3) Two (6)
19. Secretropin #3 :($250)	Purchase. None One (3) Two (6)
20. Testosterone Program:($375)	Purchase requires Rx. No Supplies needed Only Needles 25G Needles & Alcohol Swabs Sharps Container All Supplies
21. Female Hormone Program:($25)	Purchase requires Rx. None One (1) Two (2)
First name:	* required
Last name:	* required
Phone:	* required
Email:	* required
Street Address:	* required
City:	* required
State:	* required
ZIP:	* required
Country:	* required
Credit Card Information
Purchase CODE:	NONE MDC2017 WAF2017 VIP
CC Type:	American Express Discovery MasterCard Visa
CC Number:	* required
CC Expiration:	* required
CCV:	* required
CC Zip_Code:
Please check off the box authorizing our office to package your requested supplements and to charge your credit card. We will not call you, but you will receive a copy of the credit card transaction immediately after it is APPROVED. By checking this box I authorize the charges to my credit card. I approve of these charges
Comments(Limited to 5 lines)