Your Name
*
First Name
Last Name
Email
*
How did you hear about us?
Google
ZocDoc
Instagram/Facebook
Your Blog
Referral
Tripment
Select Service
*
prev
next
( X )
One Visit
$
50.00
Three Visits
$
140.00
+10% off all supplements. Rx cost not included
Five Visits
$
225.00
+15% off all supplements. Rx cost not included
Enter coupon
Apply
Subtotal
$
0.00
Tax
$
0.00
Total
$
0.00
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Submit
Should be Empty: