DeerFields Clinic Supplement Order Form

BASIC INFORMATION

First Name: *

Last Name: *

Ship to address on file?: *

Yes

Ship to address:

Address: *

City: *

Postal Code: *

Email *

Phone Number: *

Please enter quantity

BUNDLES (10% discount from individual price)

IMMUNE SUPPORT BUNDLE. 1 OF EACH: Vitality Essentials Formula, V & L Formula, and Immune Boost Formula ($222.95)

INDIVIDUAL BOTTLES

	Vitality Essentials Formula 180 vcaps ($67.95)
	Vitality & Longevity Formula 180 vcaps ($99.95)
	Immune Boost Formula 180 vcaps ($79.95)
	Melatonin 3 mg 60 caps ($15.95)
	Omegagenics Mega 10 Fish Oil 60 gel calps ($55.95)
	Prostate Plus Formula 180 vcaps ($106.95)
	Magnesium Glycinate 180 mg 200 vcaps ($57.95)
	Methylation Formula 1 180 vcaps ($119.95)
	MSK/Pain Formula 120 vcaps ($69.95)
	SPM Active 60 gel caps ($74.95)
	Sleep Formula 1 60 vcaps ($37.95)

A final total and confirmation will be emailed to you before we process the order. All orders are subject to HST. *

HST

Shipping Charge: *

Shipping Charge: $12.00

** Shipping charges are waived on orders above $400

DeerFields

DeerFields Clinic 111 The West Mall, Etobicoke, ON, M9C 1C1 Tel 416.253.9769 Fax 416.253.4389

DeerFields Estate 17084 Duffy's Lane, Palgrave, ON, L7E 3C2 Tel 416.253.9769 Fax 416.253.4389

www.deerfields.ca

clinic@deerfields.ca