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Must Complete History form before ordering allergy drops
History Form
Order Allergy drops
Home
Questions & More Information
About
X
History Form
Order Form
History Form
Order Form
Home
Questions & More Information
About
Home
Questions & More Information
About
Order Form
Home
Order Form
You must fill out the History Form before Ordering
Name
Date
Email Address
Phone
Street Address
City
State/Province
ZIP / Postal Code
Allergy Drop Selection (☑ Check one)
Dog Allergy Drops – $69/month + shipping
Cat Allergy Drops – $69/month + shipping
Dog + Cat Allergy Drops – $79/month + shipping
Supply Preference (☑ Check one)
1-Month Supply + shipping
2-Month Supply + shipping (refrigerate second vial)
Credit / Debit Card
*
Agreement
*
I understand that allergy drops are customized and non-refundable.
I will store vials as directed (one refrigerated, one at room temperature).
I acknowledge that insurance is not accepted and I am responsible for payment.
I agree to all the above terms
Submit
