You are here: Home > Did you know you can FAX or EMAIL your order too? Here's how...

TO RECEIVE FREE PRIORITY HANDLING on your order, you may use the FOLLOWING on-screen-fillable web order form instead.  The following form is for credit card orders only. Please continue with the checkout process if you wish to checkout using Paypal.

INSTRUCTIONS: Clicking on the following thumb will take you to our secure (https) web order form page. Complete the form in seconds on-screen, then PRINT > SIGN > FAX it to our Ordering Department (no cover page necessary) at 949-203-6178. Alternatively, saving the blank form to your desktop and completing it offline will also allow you to fill it in just as easily on-screen, but allow you to save the form with your responses, so that you can then conveniently attach it in email to  

Ideal for busy physicians, this form can be filled out in under a minute. Click on either the image or the visible link below to load the form on screen.  Both are secure.