Telemedicine Patient Order Form(please forward your completed order to dallasteam@mettrimmd.net)

Breakfast

Honey Nut Cereal Cinnamon Cereal Pancake Mix Chocolate Chip (5 packets per box) (5 packets per box) (7 packets per box) Pancake Mix (7 packets per box)

Qty. 0 Qty. 0 Qty. 0 Qty. 0

Blueberry Breakfast Sampler Vegetable Bacon & Cheese Pancake Mix (7 packets per box) Omelet Mix Omelet Mix(7 packets per box) (7 packets per box) (7 packets per box)

Qty. 0 Qty. 0 Qty. 0 Qty. 0

South Western Maple Brown Sugar Apple Cinnamon Cheese & Chive Omelet Mix Oatmeal Oatmeal Egg Scramble Mix(7 packets per box) (6 packets per box) (6 packets per box) (7 packets per box)

Qty. 0 Qty. 0 Qty. 0 Qty. 0

Breakfast

Maple Blueberry Maple Walnut Strawberry Pancake Syrup Pancake Syrup Pancake Syrup Pancake Syrup

Qty. 0 Qty. 0 Qty. 0 Qty. 0

French Vanilla Hazelnut Caramel Coffee Creamer Coffee Creamer Coffee Creamer Qty. 0 Qty. 0 Qty. 0

Protein Drinks (Hot)

Cappuccino Hot Chocolate Pumpkin Spice Latte Drink Mix Drink Mix Drink Mix(7 packets per box) (7 packets per box) (7 packets per box) Qty. 0 Qty. 0 Qty. 0

Protein Drinks (Cold- Concentrate and Powder)

Strawberry Banana Grape Blue Raspberry Cranberry & Tea Concentrate Concentrate Concentrate Concentrate(7 packets per box) (7 packets per box) (7 packets per box) (7 packets per box)

Qty. 0 Qty. 0 Qty. 0 Qty. 0

Pink Lemonade Peach Mango Tea Berry Blast Orange Powder Powder Powder Powder(7 packets per box) (7 packets per box) (7 packets per box) (7 packets per box)

Qty. 0 Qty. 0 Qty. 0 Qty. 0Protein Shots

CranGrape Orange Apple Pink Lemonade

Protein Shot Protein Shot Protein Shot Protein Shot (1 bottle) (1 bottle) (1 bottle) (1 bottle)

Qty. 0 Qty. 0 Qty. 0 Qty. 0

Protein Shakes (Breakfast, Lunch and/or Dinner Option)

Smoothie Base Pina Colada Strawberry Vanilla Bean Mix Flavor Pack Flavor Pack Flavor Pack(7 packets per box) (7 packets per box) (7 packets per box) (7 packets per box)

Qty. 0 Qty. 0 Qty. 0 Qty. 0

Blueberry Delight Chocolate Indulgence Smoothie Variety Pack Lemon Razzy Flavor Pack Flavor Pack Mix & Flavor Packs Bottled Shake Mix(7 packets per box) (7 packets per box) (7 packets per box) (6 bottles)

Qty. 0 Qty. 0 Qty. 0 Qty. 0

Wild Berry Splash Mango Splash Chocolate Salted Caramel ChocolateBottled Shake Mix Bottled Shake Mix Bottled Shake Mix Bottled Shake Mix

(6 bottles) (6 bottles) (6 bottles) (6 bottles)Qty. 0 Qty. 0 Qty. 0 Qty. 0

Protein Shakes (Breakfast, Lunch and/or Dinner Option)

Chocolate Vanilla Café Latte Bottled Shake Mix Bottled Shake Mix Ready to Serve Shake (6 bottles) (6 bottles) (6 bottles) Qty. 0 Qty. 0 Qty. 0

Field Berry Chocolate Vanilla Vanilla Ready to Serve Shake Ready to Serve Shake Ready To Serve Shake High Protein Mix (8 bottles) (6 bottles) (6 bottles) (7 packets per box) Qty. 0 Qty. 0 Qty. 0 Qty. 0Protein Bars (Mid-Morning and/or Mid-Afternoon Snack Option)

Fluffy Vanilla Crisp Fluffy Nutter Salted Toffee Pretzel Strawberry Shortcake Protein Bars Protein Bars Protein Bars Protein Bars

(7 bars per box) (7 bars per box) (7 bars per box) (7 bars per box)Qty. 0 Qty. 0 Qty. 0 Qty. 0

Protein Bars (Mid-Morning and/or Mid-Afternoon Snack Option)

Zesty Lemon Crisp Chocolate Crisp Caramel Nut Crispy Variety Pack Protein Bars Protein Bars Protein Bars Protein Bars (7 bars per box) (7 bars per box) (7 bars per box) (7 bars per box)

Qty. 0 Qty. 0 Qty. 0 Qty. 0

Peanut Butter Crisp Vanilla Crisp Caramel Sea Salt Variety Chewy Pack Protein Bars Protein Bars Protein Bars Protein Bars (7 bars per box) (7 bars per box) (7 bars per box) (7 bars per box) Qty. 0 Qty. 0 Qty. 0 Qty. 0

Caramel Nut Chewy Peanut Butter Chewy Rockie Road Chewy Caramel Nut Chewy

Protein Bars Protein Bars Protein Bars Protein Bars (7 bars per box) (7 bars per box) (7 bars per box) (7 bars per box) Qty. 0 Qty. 0 Qty. 0 Qty. 0

Sweet Snacks (Mid-Morning and/or Mid-Afternoon Snack Option)

Vanilla Strawberry Caramel Café Latte ChocolateShake/Pudding Mix Shake/Pudding Mix Shake/Pudding Mix Shake/Pudding Mix(7 packets per box) (7 packets per box) (7 packets per box) (7 packets per box)

Qty. 0 Qty. 0 Qty. 0 Qty. 0

Raspberry Strawberry Banana Chocolate Peanut & Caramel Gelatin Mix Gelatin Mix Soy Snacks Soy Snacks(7 packets per box) (7 packets per box) (7 bags per box) (7 bags per box)

Qty. 0 Qty. 0 Qty. 0 Qty. 0

Soft Baked Chocolate Chip Oatmeal Raisin Chocolate Sandwich Brownie Mix Cookie Cookies Cookies(7 packets per box) (7 cookies per box) (7 cookies per box) (7 packets per box)

Qty. 0 Qty. 0 Qty. 0 Qty. 0

Sweet Snacks (Mid-Morning and/or Mid-Afternoon Snack Option)

Chocolate & Caramel Lemon Raspberry Chocolate Granola Snacks Wafers Wafers Wafers(7 packets per box) (5 wafers per box) (5 wafers per box) (5 wafers per box) Qty. 0 Qty. 0 Qty. 0 Qty. 0

Savory Snacks (Mid-Morning and/or Mid-Afternoon Snack Option)

Nacho Cheese Ranch Crunch Barbeque Crunch Pizza Crunch

Chips Chips Chips Chips(1 bag of chips) (1 bag of chips) (1 bag of chips) (1 bag of chips)

Qty. 0 Qty. 0 Qty. 0 Qty. 0

Chipotle BBQ Sour Cream & Fine Herb Zipper Snacks Zipper Snacks

(7 bags per box) (7 bags per box) Qty. 0 Qty. 0

Soups (Lunch and/or Dinner Option)

Hot Base Cheddar & Broccoli* Chicken & Vegetable* Soup Mix Flavor Pack Flavor Pack(7 packets per box) (7 packets per box) (7 packets per box) Qty. 0 Qty. 0 Qty. 0

Chicken Noodle Cream of Chicken Cream of Mushroom Italian Tomato

Soup Mix Soup Mix Soup Mix Soup Mix(7 packets per box) (7 packets per box) (7 packets per box) (7 packets per box)

Qty. 0 Qty. 0 Qty. 0 Qty. 0

Entrées (Lunch or Dinner Option)

Vegetable Chili Chicken Alfredo Pasta Spaghetti Bolognese Vegan Chicken Curry

Entrée Entrée Entrée Entrée(7 entrées per box) (7 entrées per box) (7 entrées per box) (7 entrées per box)

Qty. 0 Qty. 0 Qty. 0 Qty. 0

*Requires Hot Base Soup Mix

Entrées (Lunch or Dinner Option)

Creamy Mac & Cheese High Protein Fusilli Asian Inspired Chicken Pasta Entrée Entrée Sauce Entrée (7 entrées per box) (7 entrées per box) (7 packets per box) (1 entrée)

Qty. 0 Qty. 0 Qty. 0 Qty. 0

Turkey Chili Pasta Fagioli Green Pepper Steak Vegetable Stew

Entrée Entrée Entrée Entrée(1 entrée) (1 entrée) (1 entrée) (1 entrée)

Qty. 0 Qty. 0 Qty. 0 Qty. 0

Beef Stroganoff Spaghetti & Meatballs Chicken Enchilada Verde 5 Bean Casserole

Entrée Entrée Entrée Entrée(1 entrée) (1 entrée) (1 entrée) (1 entrée)

Qty. 0 Qty. 0 Qty. 0 Qty. 0

Entrées (Lunch or Dinner Option)

Beef Pot Roast Vegetable Lasagna Entrée Entrée (1 entrée) (1 entrée) Qty. 0 Qty. 0Supplements

SOMA-Vit SOMA-EFA SmartSlim ThermoCaps Vitamin ‘Fish Oil’ Hunger Suppressing Metabolism Booster (30 tablets) (120 capsules) (90 capsules) (90 capsules)

Qty. 0 Qty. 0 Qty. 0 Qty. 0Extras

MetTrimMD Blender Bottle (1 bottle) Qty. 0