Allergy Serum Request

  • Personal Information

  • Date Format: MM slash DD slash YYYY
  • Order Information

  • Name on label
  • Shipping Information

  • Payment

    One Set: $140.00

    Two Sets: $240.00

    Shipping: $7.51

    NOTICE: After submitting this request there will be instructions for payment.

  • Terms

    By completing and submitting this form electronically you are agreeing to be responsible for the payment of the serum ordered. Serum will be available for pick-up seven days from the date you placed the order. If you are requesting it to be mailed, please allow ten business days for shipping.