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Please be advised that once you submit your order we will charge the card on file and process your refill. ALL SALES ARE FINAL *

Please use the card you have on file and process my order.

ONLY SUBMIT THIS FORM ONCE. ONCE THIS FORM IS SUBMITTED, PLEASE DO NOT TRY TO REQUEST THE ORDER BY PHONE OR THROUGH THE PATIENT PORTAL OR YOU RISK DOUBLE PROCESSING. Shipping will be added to all orders. Syringes are not included in the Special Peptide Promotion and will be added afterwards.

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