Asheville Integrative Medicine

832 Hendersonville Road
Asheville, NC 28803 (map)

cutting edge, state of the art INTEGRATIVE MEDICINE
for achieving OPTIMAL HEALTH

Allergy Serum Reorder Form

To avoid missing doses, please remember to reorder your drops at least 10 business days before you will run out. Your drops will be mailed directly to the address you list below. You will be charged the cost of your drops at the time you order. Please provide a credit card number, or mail a check with the order form (made payable to "AIM").

Please check which drops you are ordering Inhalant drops $110 Complex Inhalant drops (contains more than 20 allergens) $130 Food drops $165 Additional food drop vials (more than 17 allergens in order) $110 each Both Food and Inhalant drops $250
Name:
Address
Phone Number
Credit Card Number
Expiration Date
v Code
I authorize Asheville Integrative Medicine to charge my credit card for the amount selected above (check yes) Yes
Email Address:

Or, click here to download a printable form which you can mail or fax into our office.