Patient Re-Order Form

Fernhill Wellbeing Centre

PATIENT RE-ORDER FORM

FAX ORDERS TO 02 67 210398

Note:Existing patients only

ü ALL ORDERS WILL BE PROCESSED WITHIN 24 HOURS

ü ALL ORDERS OVER $100 WILL BE POSTED FREIGHT FREE

Name………………………………………………

Postal address……………………………………

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State………………………….Postcode…………

Ph number………………………………………..

Qty....Supplement...........................Price

……. Beta A-C powder....................$35.95 

....... Chondrosamine 250g...............$55.95

....... Chondrosamine 500g...............$89.95

....... Echinacea Royale 60 tabs.......$35.95

....... Herbs 200ml...........................$37.50

....... Herbs 500ml...........................$72.00

....... Meta 60..................................$27.95

....... Meta 120................................$49.95

....... MetaZinc................................$18.50

....... Iron........................................$15.70

....... Osteoplus...............................$29.95

....... Sodium Ascorbate 125g...........$13.90

....... Tresos B 50 tabs.....................$27.95

....... Tresos B 150 tabs...................$72.70

....... Zinc........................................$19.95

Other ...………………………………………………………………

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Post to the above address (Out of town only)

Deliver to the Dust Jacket

Collect from Clinic (Please specify date and approx time of pickup)……………….

My credit card details are M/C Visa

Number……………………………………………… exp……….

Signature……………………………………………………………...