Dr. Bryan Schuetz, Capital City Chiropractic & Wellness Center, 5577 North High Street, Worthington, OH 43085 (614) 436-3870

Here is a printable form for your convenience.  Simply fill it out, print it and send to:
Bryan Schuetz, D.C., Capital City Chiropractic & Wellness Center 5577 North High Street, Worthington, OH 43085

Capital CityChiropractic & Wellness Center's Order Form

Item Quantity Item Quantity
Anti-OX-Plus Nutritional Foundation
Artho-Mend Premensyn
Cal-Mag 2000 Prosta-Flow
Cholestol Proteo Plus
Digest-Zyme SerenQuility
Gluco-Zyme SinuPro
Immu-Forte Thera-Fibron
Neuro B6 Vascu-Flow
Nutra-Calm Vitality Plus
Nutra-Mend
Email Address

Credit Card details
Name Name on Card 
Company Card Type 
Address Card Number 
Address Expiry Date 
Town/City Your Signature: (same as card)

_________________________________________________
State ATTENTION:  On orders under $75.00 there will be a $5.00
shipping charge.
Postcode ATTENTION:  On orders over $75.00 there is NO shipping charge.
Country ATTENTION OHIO RESIDENTS:  Please note we will be adding five percent to your total order for sales tax.
Phone
Fax

Copyright 1999. Dr. Bryan Schuetz,The Healthy Site.com.  Capital City Chiropractic & Wellness Center. All RightsReserved. Email: doc@thehealthysite.com

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