Thorne Research Price List - Updated 1 August 2005 med Patient Order.… · Web view24 TEA-PV...
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Page 1 Patient Order Practitio ner: POST $8.50 - Please allow 3-10 working days COURIER $20.00 - Please allow 2-6 working days FxMed products are authorized as practitioner-only supplements. Any patient sales must have approval from a FxMed-Registered Practitioner. FxMed provides these supplements under this agreement. I herby certify that the products ordered are for my, and/or my immediate family’s personal use. SIGNATURE: _________________________ PRINT NAME: ________________________ DATE: __________________ IF PAYING BY CREDIT CARD, ‘FIML’ IS OUR COMPANY NAME WHICH WILL APPEAR ON YOUR CREDIT CARD STATEMENT Freefax 1800 665 070 Functional and Integrative Medicine Ltd (FIML), PO Box 19033, 77 Austin Street, Onekawa, Napier 4146, New Zealand Ph. 1800 770 904 | [email protected] PLEASE PROVIDE AT LEAST ONE MEANS OF CONTACT IN CASE WE NEED TO CONTACT YOU ABOUT YOUR ORDER FXMED OPERATES A BACK-ORDER SYSTEM. OUT-OF-STOCK ITEMS WILL BE BACK-ORDERED AND ADVICE GIVEN AS TO EXPECTED DELIVERY DATE. ANY BACK-ORDERED ITEMS WILL BE DELIVERED AS SOON AS THEY ARE AVAILABLE. Functional and Integrative Medicine Ltd, (NAB) BSB 082-057 #86-599-4569 PATIENT NAME (PLEASE PRINT CLEARLY) ADDRESS ADDRESS SUBURB / CITY STATE POST CODE DAY PHONE/S EMAIL SPECIAL DELIVERY INSTRUCTIONS FxMed is not responsible for any goods left at premises. Above prices are for Australia deliveries only. AMOUNT (INCLUDING FREIGHT) CREDIT CARD NUMBER CARD EXPIRY DATE CARD HOLDER NAME CARD HOLDER SIGNATURE Jason Eldridge
Transcript of Thorne Research Price List - Updated 1 August 2005 med Patient Order.… · Web view24 TEA-PV...
Page 1Last updated April
2011
Patient Order Form
Practitioner:
POST $8.50 - Please allow 3-10 working days
COURIER $20.00 - Please allow 2-6 working days
FxMed products are authorized as practitioner-only supplements. Any patient sales must have approval from a FxMed-Registered Practitioner. FxMed provides these supplements under this agreement.
I herby certify that the products ordered are for my, and/or my immediate family’s personal use.
SIGNATURE: _________________________ PRINT NAME: ________________________ DATE: __________________
IF PAYING BY CREDIT CARD, ‘FIML’ IS OUR COMPANY NAME WHICH WILL APPEAR ON YOUR CREDIT CARD STATEMENT
Freefax 1800 665 070Functional and Integrative Medicine Ltd (FIML), PO Box 19033, 77 Austin Street, Onekawa, Napier 4146, New Zealand
Ph. 1800 770 904 | [email protected]
PLEASE PROVIDE AT LEAST ONE MEANS OF CONTACT IN CASE WE NEED TO CONTACT YOU ABOUT YOUR ORDER
FXMED OPERATES A BACK-ORDER SYSTEM. OUT-OF-STOCK ITEMS WILL BE BACK-ORDERED AND ADVICE GIVEN AS TO EXPECTED DELIVERY DATE.ANY BACK-ORDERED ITEMS WILL BE DELIVERED AS SOON AS THEY ARE AVAILABLE.
Functional and Integrative Medicine Ltd, (NAB) BSB 082-057 #86-599-4569
PATIENT NAME (PLEASE PRINT CLEARLY) ADDRESS
ADDRESS SUBURB / CITY STATE POST CODE
DAY PHONE/S
SPECIAL DELIVERY INSTRUCTIONS
FxMed is not responsible for any goods left at premises. Above prices are for Australia deliveries only.
AMOUNT (INCLUDING FREIGHT) CREDIT CARD NUMBER CARD EXPIRY DATE
CARD HOLDER NAME CARD HOLDER SIGNATURE
Jason Eldridge
Practitioner name: _________________________
Patient Name: _________________________
All prices are in Australian dollars
PRODUCT NAME VOL PRODCODE RRP $
Quantity Required
THORNE RESEARCH5-Hydroxy-Tryptophan 90s SA503 46.40
5-Methyl-tetra-hydro-folate 60s B129 27.80
Adrenal Cortex 60s SG803 14.70
Als Formula (Men over 40) 240s VMM 67.70
Anti-Oxidant 90s SF709 34.50
Arabinex 100gm SP619 51.20
Ar-Encap 240s SF774 53.20
Artecin (Artemisia annua) 90s SF736 33.50
B.P.P.Betaine (Pancreatin/Pepsin) 180s SD410 43.10
Bacopa Moniera 60s SF728 14.40
Basic B Complex 60s B104 26.70
Basic Detox Nutrients 360s VMD 85.70
Basic Immune Nutrients 360s VMH 190.50
Basic Nutrients I (Aspartate) 180s VM1 47.90
Basic Nutrients II (Aspartate) 180s VM3 47.90
Basic Nutrients III (Citrate) 180s VM6 50.30
Basic Nutrients IV (Citrate) 180s VM7 50.30
Basic Nutrients V (Citrate-Malate) 180s VM5 50.30
Basic Prenatal 90s VMP 26.30
Basic Pygeum Herbal 60s SF761 35.30
B-Complex #1 60s B101 21.50
B-Complex #3 60s B103 19.40
B-Complex #5 60s B105 18.50
B-Complex #6 60s B106 23.30
B-Complex #12 60s B112 19.40
Berbercap (200mg) 60s SF760 31.50
Betaine HCL/Pepsin 625s SD414 36.00
Betaine HCL/Pepsin 225s SD415 78.00
Bio-B12 60s B120 21.80
BioDERM 60s SP650 74.40
Bio-Gest 60s SD404 23.00
Bio-Gest 180s SD405 57.80
Biomins (With Cu & Fe) 90s M201 24.00
PRODUCT NAME VOL PRODCODE RRP $
Quantity Required
Biomin II (Without Cu or Fe) 90s M202 24.00
Bio-PMT 60s SF710 24.30
Biotin-8 (8000mcg) 60s B118 34.50
Black Currant Oil 60s SP602 27.80
Black Currant Oil 180s SP604 76.50
Boron Picolinate (3mg) 60s M264 12.80
Buffered C Powder 227gm C155 27.80
Calcium CitraMate (160mg) 90s M270 16.50
Calcium Citrate (150mg) 90s M217 17.10
Calcium D Glucarate 90s M280 59.90
Calcium-Magnesium CitraMate (80/80mg) 90s M271 16.50
Calcium-Magnesium CitraMate (80/80mg) 240s M273 39.00
Calcium-Magnesium Citrate (80/80mg) 90s M218 16.80
Cal-Mag Citrate Effervescent Powder 227gm M222 20.60
Captomer (DMSA) 100 45s SF740 66.00
Captomer (DMSA) 250 45s SF735 152.30
Carnityl (500mg) 60s SA520 73.60
Childrens Basic Nutrients 180s VMC 27.00
Choleast (Red Yeast Rice) 120s SF751 57.00
Chromium Picolinate (500mcg) 60s M255 20.30
Citramins (with Cu & Fe) 90s M249 23.00
Citramins II (without Cu or Fe) 90s M250 23.00
Co10 (30mg) 90s SF721 33.50
Coleus Forskohlii 60s SF756 18.90
Collag-en 60s SG806 22.20
Copper Picolinate (2mg) 60s M257 12.90
CO-Q-100 (100mg) 90s SF719 82.50
CO-Q-100 Softgel 90s SP617 82.50
Cortine 60s SG802 15.80
Cortrex 60s SG801 24.80
Crucera-SGS 60s SP660 67.70
Page 1 subtotal $
CystePlus (500mg) 90s SA560 35.30
D-1000 (Vitamin D3) 90s D128 13.80
Practitioner name: _________________________
Patient Name: _________________________
PRODUCT NAME VOL PRODCODE RRP $
Quantity Required
D-5000 (Vitamins D3) 60s D138 21.80
DHA from Algae 90s SP609 88.30
Diabenil 90s SF790 64.60
Diosmin-HMC 60s SB333 27.00
Dipan-9 (Pure Pancreatin) 60s SD400 44.90
Dipan-9 (Pure Pancreatin) 180s SD401 110.10
DL-Phenylalanine (550mg) 60s SA550 28.80
E-500 (Water Soluble) 60s E142 28.50
Extra Nutrients 180s VMX 67.70
Ferrasorb 60s SF750 21.20
Fibrovive 180s SF704 101.50
Folacal 60s B130 20.30
Folic Acid Liquid 60ml B123 14.30
Formaldehyde Relief 90s SF793 52.40
Formula SF722 250s SF722 44.90
Formula SF734 90s SF734 26.90
Fractioned Pectin (450mg) 90s SF779 35.90
Fractioned Pectin Powder 141gm SF778 71.20
GB24 90s SF739 26.90
Gl-Encap 60s SF703 18.80
Glucosamine & Chondroitin 90s AUSF767 42.90
Glucosamine Sulfate 90s AUSF776 20.90
Glucosamine Sulfate 180s SF777 41.40
Glutathione SR (Reduced 175mg) 60s SA540 52.30
Glycine 250s AUSA512 25.10
Green Tea Phytosome 60s SB336 28.10
Heavy Metal Support 120s SF795 36.60
Herbal Laxative 90s SF768 20.90
HMC-Hesperidin 60s SB324 21.60
Hydrolyzed Whey (Lactalbumin) Protein 510gm SP623 56.60
Hyper-Ex (300mg) 90s SF729 24.80
IM-Encap 60s SG820 20.10
IM-Encap 180s SG821 48.20
Indole-3-Carbinol 60s SF749 39.80
Iodine - Tyrosine 60s M219 22.40
PRODUCT NAME VOL PRODCODE RRP $
Quantity Required
Ipriflavone 90s SB345 40.20
Iron Citrate (25mg) 60s M238 11.30
Iron Picolinate (25mg) 60s M258 18.50
Isatis (Isatis tinctoria) 60s SF764 17.10
Iso-Phos 60s SF715 73.20
Krill Oil Plus 60s SP613 80.10
Lactobacillus Sporogenes 60s SF758 26.90
L-Carnitine Caps (330mg) 60s SA502 54.90
L-Glutamine (500mg) caps 90s SA518 23.30
L-Glutamine Powder 340gm SA519 64.10
Lipotrepein 60s SF700 16.40
Liver Cleanse 60s SF769 17.90
L-Lysine (500mg) 60s SA516 12.60
L-Tryptophan 60s SA501 51.80
L-Tyrosine (500mg) 90s AUSA514 27.00
M.F. Bromelain (3200mcu/500mg) 60s SB315 40.70
Magnesium Aspartate 90s M213 14.90
Magnesium CitraMate (150mg) 90s M272 17.90
Magnesium Citrate (140mg) 90s AUM234 17.90
Manganese Picolinate (15mg) 60s M211 12.30
Medibulk 227gm SP621 21.00
Mediclear 920gm SP640 79.50
Mediclear Plus 920gm SP645 88.50
Medipro - Protein Supplement 510gm SP620 59.40
Melaton - 1mg 90s SF781 18.00
Melaton - 3mg 60s SF788 25.40
Melaton - 5mg 60s SF780 34.40
Memoractiv 60s SF737 91.50
Meriva SR (curcumin) 120s SF775 44.90
Meta-Balance 120s SF711 33.80
Page 2 subtotal $
Meta Fem (Women over 40) 240s VMW 57.50
Metaplex 150s SA505 56.90
Methylcobalamin 60s B125 31.40
MethylGuard 180s SF787 59.50
Practitioner name: _________________________
Patient Name: _________________________
PRODUCT NAME VOL PRODCODE RRP $
Quantity Required
Moducare 90s SP633 50.50
Molybdenum Picolinate (1mg) 60s M260 13.40
MSM -750 240s SF712 38.40
Myco-Immune 60ml SP629 46.50
Myorel 60s SF772 25.40
Neo-Cardio 90s SF716 38.00
Neurochondria 90s SF738 93.90
Niacinamide (500mg) 180s B131 23.60
Niasafe-600 60s B113 29.90
Niasafe-600 180s B114 81.00
Nutri -ADD 60s SF754 90.80
Nutri Fem (Women under 40) 240s VMF 54.90
O.P.C.-100 (100mg Pycnogenols) 60s SF745 54.90
Ocu Clear 90s SF798 66.00
Olive Leaf Extract 60s SF763 33.80
Omega Plus (EPA & GLA) 90s SP607 44.00
Oscap 120s SG822 24.80
Oscap Plus 180s SG823 53.30
Pantethine 250 mg 60s SF706 42.80
Perfusia SR 120s SA525 51.20
Perma-Clear 180s SF741 78.10
Pesticide Protector 90s SF794 34.10
Pharmacol-40 90s SP651 60.50
Phosphatidyl Choline 60s SP605 21.80
Phytisone 60s SG804 18.90
Phytogen 60s SF724 18.90
Phytogen 180s SF725 46.20
Phytoprofen 60s SF799 30.90
Pic-Mins 90s M243 25.40
Plantioxidants 60s SF701 39.30
Plantizyme 90s SD403 55.10
Policosanol 60s SF708 20.30
PolyResveratrol-SR 60s SB300 66.30
Potassium Citrate (99mg) 90s M240 16.40
Potassium Magnesium Aspartate 90s M216 16.40
PRODUCT NAME VOL PRODCODE RRP $
Quantity Required
Potassium Magnesium Citrate (99/70mg) 90s M241 16.40
Pure Ascorbic Acid Caps (500mg) 180s C150 25.20
Pure Ascorbic Acid Caps (1 gm) 250s C149 50.60
PureLyte Orange 920gm SP655 16.50
PureLyte Pediatric Orange 920gm SP657 19.50
Pyridoxal 5' Phosphate 60s AUB116 23.90
Pyridoxal 5' Phosphate 180s B126 53.30
Q10 Plus 90s SF713 47.70
QC Nasal Spray 30ml SB331 23.00
Quercenase (Bromelaine and Quercetin) 60s SB332 35.10
Quercetone (250mg) 60s SB330 30.00
R-Lipoic Acid 60s SF771 55.10
Rhodiola Rosea 60s SF755 19.80
Riboflavin 5' Phosphate 60s AUB115 16.40
S.A.T. 60s SF732 30.20
Sacro-B (250mg) 60s SF757 50.90
Sedaplus 60s SF770 25.10
Selenium Citrate (200mcg) 60s M236 11.00
Selenium Picolinate (200mcg) 60s M256 15.20
Serenoa Gelcaps 60s SF762 24.50
Siliphos 90 SF733 51.20
Solvent Remover 90s SF796 29.30
Soy Isoflavones 60s SB341 40.10
Sulfonil 60s SF783 26.70
Super EPA (EPA 425 / DHA 270) 90s SP608 44.90
Supportive Care 210s SFSC 109.20
Supportive Care II 300s SFSD 68.00
Synergisti-C 60s C160 20.90
Page 3 subtotal $
T.A.P.S 60s SF773 36.60
T. Asthmatica Plus 120s SF766 44.90
Taurine (500mg) 90s SA511 17.30
Theanine 90s SA508 66.00
Thiocid (Lipoic Acid) 60s SF786 27.30
Thyrocsin 60s SF765 21.80
Practitioner name: _________________________
Patient Name: _________________________
PRODUCT NAME VOL PRODCODE RRP $
Quantity Required
Toxic Relief Booster 90s SF782 51.80
Trace Minerals(Zn/Mn/Cr/Se/Mo/v) 90s M242 23.30
Traumogen 180s SF723 42.20
Tri Spartate 60s M203 16.10
Ultimate E 60s E143 40.80
UltraChrome 200 (200mcg) 60s M274 11.90
UltraChrome 500 (500mcg) 60s M276 18.90
Undecyn 100s SF742 27.80
Uristatin 60s SF726 25.40
Vacimyr 45s SF748 26.00
Vanoxyl 5 90s M266 11.40
Vanoxyl 25 90s M267 27.00
Venocap 120s SF759 44.90
Vinpocetine 90s SB360 31.50
Vitamin A 25000IU 90s A97 14.90
Vitamin C with Flavonoids 180s C152 29.90
Vitamin D liquid 30ml D168 19.40
Vitamin D + Vitamin K2 liquid 30ml KD500 30.20
Vitamin K2 liquid 30ml K170 83.80
Zinc Citrate (30mg) 60s M239 11.60
Zinc Picolinate (15mg) 60s M210 13.20
Zinc Picolinate (30mg) 60’s M220 20.40
Zinc Picolinate (30mg) 180’s M221 50.30
Zinc Sulphate7-Hydrate 236ml ZN 8.70
METABOLIC MAINTENANCE5- HTP 50mg 60s R5HTP50M
G 26.40
Acetyl L-Carnitine 60s RACETYLLCARN 30.80
Alpha Kg+ 60s RALPHAKG60 24.00
Alpha Lipoic Acid 90s RLIPOIC100 38.10
Amino Acid Blend 400gm RCUSTOMAMINO 73.50
Anxiety Control 90s RANXIETYCONTRO 39.80
B.A.M. 750mg 90s RBAM90 37.50
B-Complex 100s RBCOMPLEX 37.50
Brain Cell Support 60s 00669 66.60
PRODUCT NAME VOL PRODCODE RRP $
Quantity Required
Buffered C capsules 100s RKMGASCOR500 32.10
Cal Mag Citrate 1:1 120s RCALMAG1:1 26.60
Cal Mag Powder 2:1 390gms HCALMAGPWDR 32.10
Cal Mag Zinc w/ 400IU Vit D 120s RCALMAGZINCD 24.00
Cal Mag Zinc w/ 2000IU Vit D 120s 00401 27.00
Cal Mag Zinc Plus w/ 2000IU Vit D, and Vit K 120s 41.30
Co Enzyme Q10 - 100mg 60s RCOQ100MG 48.80
Cranberry with Probiotics 100s RCRANWPROBIOTI 41.30
Custom Amino Acid Base Powder 200gm AMINOACI
D 67.50
Deluxe Detox Formula 90s RDETOX 50.30
Deluxe Scavengers 90's 90s RDELUXE90 48.80
Deluxe Scavengers 180's 180s RDELUXE180 82.50
DIM Complex 100mg 60s RDIM 37.50
D-Ribose 450gm DRIBOSE 95.40
L-Arginine 500mg 100s RLARGININE 24.80
L-Carnitine 250mg 60s HLCARNITINE 33.00
L-Glutamine 500mg 100s LGLUTAMINE 26.40
L-Glutathione 100mg 60's RLGLUTATHIONE 30.00
L-Methionine 100's RLMETHIONINE 27.30
L-Tyrosine (500mg) 100’s RLTYROSINE 32.10
Metabolic Detox Complete 60’s DETOXCOMPLETE 70.20
Metabolic X 60’s 00657 35.30
MetaCalm 120s 00670 53.60
Microbial Maintenance 140’s 00661 66.00
Microbial Maintenance Plus 140’s 00667 116.90
Multi Vitamin Powder 270gm HMULTIVITPWDR 44.30
Page 4 subtotal $
NAC 600mg 60's RNAC 27.30
Natural Progeste Cream 100ml 00530 48.00
Pediatric Multi Vitamin powder (60 day supply)
60 serves 00643 34.50
PS-100 (Phosphatidylserine) 60’s METABOLICS - PHOS 59.60
Potassium/Magnesium Aspartate 120s
R-POTASSIU
M29.10
Potassium/Magnesium Citrate 250s KMCIT250 44.90
Pyridoxal 5'Phosphate 50mg 100's RP5P 29.70
Rebuild Osteoporosis Formula 180’s METABOLICS-REB 36.80
Practitioner name: _________________________
Patient Name: _________________________
PRODUCT NAME VOL PRODCODE RRP $
Quantity Required
Selenium 200mcg 90's RSELENIUM 25.50
Silymarin-Milk Thistle extract 60's RMILK 28.40
Spectrum Awakening powder 90gm 00650 58.50
Taurine 100’s METABOLICS-00158 26.90
The Big One without Iron 100's RBIGW/OUT 42.00
Thin Stick 30 sticks 00665 44.10
Vital Eyes Complete 90's RVITALDELUXE 71.90
Zinc Picolinate-30mg 100's RZINCPIC 20.90
Zinc Plus 100's CDMZINCPLUS 24.80
Zinc Plus & E 100’s CDZINCPLUSE 27.80
NORDIC NATURALSArctic Cod Liver Oil - capsules (lemon) 90s N PUS-57784
-L 35.00
Arctic Cod Liver Oil - capsules (lemon) 180s N PUS-57885 61.10
Arctic Cod Liver Oil - liquid (lemon) 237ml N PUS-58784 36.60
Arctic Cod Liver Oil - liquid (orange) 237ml N PUS-54784 36.60
Arctic Cod Liver Oil – liquid (orange) 474ml N PUS-54786 65.80
Arctic Cod Liver Oil - liquid (peach) 237ml N PUS-55784 36.60
Arctic Cod Liver Oil - liquid (strawberry) 237ml N PUS-56781 36.60
Arctic Cod Liver Oil - liquid (unflavoured) 237ml N PUS-53784 36.60
Arctic-D Cod Liver Oil – (lemon) 237ml N PUS-58782 39.00
Arctic-D Cod Liver Oil – (orange) 237ml N PUS-54780 39.00
Arctic Omega – capsules (lemon) 90s N PUS-
3101 34.40
Arctic Omega – capsules (plain) 90s N PUS-
3100 34.40
Arctic Omega-liquid(lemon) 237ml N PUS-4103 42.10
Balanced Omega Combination – capsules (lemon) 180s N PUS-50501 50.30
DHA Infant plain 2oz 60 ml N PUS-53788 25.90
DHA Junior – capsules (strawberry) 180s N PUS-03180 36.00
DHA Junior – liquid (strawberry) 119ml N PUS-03183 25.90
Nordic Berries 120s N SYN-31020 42.10
Nordic Omega-3 Fishies 30’s NUS-30140 54.00
Nordic Omega-3 Gummies 60’s NUS-30130 42.10
Nordic Omega-3 Gummy Worms - strawberry 30’s NUS-30150 42.10
Pet Cod Liver Oil, plain 237ml N RUS-53783PP 36.60
ProDHA – capsules (plain) 90s N PUS-50091 45.80
PRODUCT NAME VOL PRODCODE RRP $
Quantity Required
ProDHA – capsules (strawberry) 90s N PUS-50090 45.80
Prenatal DHA – capsules (plain) 90s N PUS-50094 45.80
ProDHA Eye 60s N PUS-50095 76.40
ProEFA – capsules (lemon) 90 N PUS-03091 42.70
ProEFA – liquid (lemon) 237ml N PUS-04092 48.80
ProEFA Xtra 60 N PUS-03090 88.40
ProEFA Junior - capsules (lemon) 90s N PUS-03093 32.10
ProEPA – capsules (lemon) 60s N PUS-07060 45.80
ProEPA – capsules (lemon) 120s N PUS-08060 82.30
ProEPA Xtra – capsules (lemon) 60s N PUS-07061 66.60
ProOmega – capsules (lemon) 60s N PUS-12120 45.80
ProOmega – capsules(lemon) 120s N PUS-13120 82.30
ProOmega – capsules(lemon) 180s N PUS-14120 114.00
ProOmega - liquid (lemon) 119ml N PUS-12123 54.40
ProOmega-D - Lemon 60s N PUS-12124 47.30
ProOmega-D - liquid (lemon) 237ml N PUS-12125 94.70
ProOmega Junior – Strawberry 90s N PUS-07100 45.80
ProOmega Blood Sugar 60s N PUS-12170 48.80
ProOmega - CoQ10 60s N PUS-12130 57.80
ProOmega Joint Xtra 90s NPUS-12141 74.80
ProOmega LDL 90s N PUS-12160 67.20
ProOmega ProBiotic 60s NPUS-12200 54.00
Vitamin D3 120s N PUS-01601 23.40
Page 5 subtotal $
AYUSH HERBSAmla Plex 342gm AS-1003 33.40
AP Mag 60s AP-1002 41.00
Arjuna Heart 90s AH 48.30
Ashwagandha 60s AS-1003 24.50
Ashwagandha 120s AS-120 43.90
Bacopa Plus 60s BP 36.10
Bio-Gymnema 90s BioGYM 42.50
Boswelya Plus 90s BOS-1005 42.50
Carditone 60s CARD 40.70
Practitioner name: _________________________
Patient Name: _________________________
Practitioner name: _________________________
Patient Name: _________________________
Practitioner name: _________________________
Patient Name: _________________________
Practitioner name: _________________________
Patient Name: _________________________
Practitioner name: _________________________
Patient Name: _________________________
Practitioner name: _________________________
Patient Name: _________________________
Practitioner name: _________________________
Patient Name: _________________________
Practitioner name: _________________________
Patient Name: _________________________
PRODUCT NAME VOL PRODCODE RRP $
Quantity Required
CoCurCumin 90s COCUR 57.00
Curcumin 90s CU 32.30
ElegFem 60s EF 39.30
FacePack 4oz AY-FP 20.50
Flucomune 90s AY-FLU 34.90
Guggal Lip 90s GU-1018 38.30
Livit-1 90s LIV-1008 33.40
Livit-2 90s LIV-1009 39.30
Macuna Plus 60s MP 39.30
Neem Plus 90s NP 38.30
Neem-Col spray 3oz NC 35.30
Pippli 60s PIP-101 25.10
Probiotic 30B 60s Prob30B 42.50
Probiotic 100B 60s Prob100B 51.90
Purush 60s P-1 39.90
Rentone 90s REN 39.90
Shilajeet Mumiyo 60s SM 39.90
Sitawari 60s SHI-1019 25.10
Trifal 90s T-1 32.30
Tylophora Plus 90s TYL 35.30
Vegenzyme 90s VEG 36.00
YoungFem 60s YF-1 39.90
Himalayan Green Tea 24 TEA-HG 6.90
ProVata Tea 24 TEA-PV 6.90
R-U-Ved Energy Tea 24 TEA-E 6.90
BIOTIVIAAcai Anti-aging 60s BIOA 34.40
Bioflu 50s BIOF 38.10
Bioforge 84s BIOFR 80.80
Bioforte 60s BIOB 50.30
BioQuench 60s BIOQ 48.50
BioShape 60s BIOSH 80.80
BioSpan + 60s BIOS 48.50
Transmax 60s BIOT 89.60
PRODUCT NAME VOL PRODCODE RRP $
Quantity Required
Transmax-TR 60s BIOTTR 98.60
COROMEGACoromega - orange 30s N/A 20.70
Coromega - orange 90s N/A 53.60
DOUGLAS LABSAdren-Plus 300 60s 7221 21.70
Adreno-Mend 120s 200529 58.90
De-Mer-ToxTM 60s 80317-60X 38.20
Executive Stress Formula 120s 4541 40.10
Hair, Skin & Nails Plus Formula 100s 82924 30.50
L-Carnosine (500mg) 30s 98731-30X 35.70
Lycopene 90s LYC 29.70
Molybdenum (250mcg) 100s MOC 14.50
SAM-E tablets (200mg) 30s 98304-30X 60.90
Strontium 90s 200242-90 30.40
Super Immune Space Sprinkles 60gr 80441 40.40
Ubiquinol-QH 30s 200239-30 60.90
UltraProtein Plus-Choc 948gr 57053-948X 73.20
UltraProtein Plus-Vanilla 948gr 57054-948X 73.20
Vegetarian Omega-3 Liquid 473 ml 57371 45.80
Page 6 subtotal $
Wobenzym N 100’s 99975-100X 50.50
iNUTRITIONALSBrainSustain - Rice Powder 600gm N/A 112.60
BrainSustain - Whey Powder 375gm N/A 112.60
BrainSustain - Kids Chocolate Powder 330gm N/A 39.40
BrainSustain – NeuroActives 60s N/A 75.50
ENADA®NADH 30s N/A 65.70
MAITAKEAmyloban 3399 120s AML180 128.00
BreastMate 120s BM120 92.00
Practitioner name: _________________________
Patient Name: _________________________
PRODUCT NAME VOL PRODCODE RRP $
Quantity Required
Maitake D-Fraction Standard 120s GD120 47.00
Maitake D-Fraction Pro 60 ml MPDF 126.20
Maitake SX-Fraction 90s GSO90 75.00
Super Cordyceps 120s WSC120 62.20
Super Corliolus 120s WTT120 51.50
Super Lion’s Mane 120s WLM120 47.00
Super Reishi 120s WRS120 47.00
OTHER PRODUCTS
Chelorex Caps – Oral Chelation Formula 540s CHELC 122.90
Chelorex Liquid – Oral Chelation Formula 32oz CHELL 129.30
Iodoral – 12.5mg I per caps 90s BID 49.50
Iodoral – 12.5mg I per caps 180s CID 89.90
Mutaflor 30’s MUTFL 100.40
Readisorb Liposomal Glutathione 4oz RSLIPOS 77.50
Readisorb MethylB12 Spray 2oz RSMETHYL 39.80
Page 7 subtotal $
Freight $
TOTAL $
IF PAYING BY CREDIT CARD, ‘FIML’ IS OUR COMPANY NAME WHICH WILL DISPLAY ON YOUR CREDIT CARD STATEMENT
Please fax, post or email this form for your first time order. You can then call or email for repeat orders.
Freefax 1800 665 070Functional and Integrative Medicine Ltd (FIML), PO Box 19033, 77 Austin Street, Onekawa, Napier 4146, New Zealand
Ph. 1800 770 904 | [email protected]
