Supplement Order Form
The Wellness Way - North Scottsdale
Please be sure to fill in the required fields and submit this form to complete your order. Please note that you are giving permission for The Wellness Way North Scottsdale to charge your credit card on file by submitting this form. All prices shown are before sales tax is applied. If placing an order to be shipped, you will be charged an additional $12-20 to cover shipping depending on order size. Supplements will be shipped same day for any forms submitted prior to 2 pm, Monday - Thursday. Friday shipments will be sent out same day if form is received prior to 11:00am.
Name
*
First Name
Last Name
Email
*
example@example.com
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Are you ordering supplement to be shipped or picked up at our office?
*
Shipped to my location
Pick-up in office
If picking up at our office, when do you plan on coming in, so we can make sure your order is ready for you?
If shipping, what address should we ship your order to?
Some patients may have multiple credit cards on file. To ensure we charge the card you desire, please list the last 4 digits on your credit card here.
*
Back
Next
Please write out the supplements you would like to purchase and the quantity of each supplement in your order. If you are on a Wellness Way Care Plan, your 10% discount on supplements will be applied during checkout by our office staff. Our office will call to confirm all supplement forms before completing your checkout.
Submit
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