Supplement Order Request

Please note: All Xymogen brand supplements can now be ordered directly from the company using our doctor code. Go to, click on the eStore link in the upper righthand corner, then click sign in, then Patients (Doctor code required), then No (I haven’t ordered before), then enter our doctor code. If you do not already have the doctor code, please call our office and we will be happy to provide it to you.
Please fill out the following form completely. Our new policy is that we can only hold supplements for 24 hours without a payment. After 24 hours, the supplements will be restocked. If you need us to hold it longer than 24 hours, you must prepay. We can also ship them to you. If you want to prepay or ship, please indicate it on the following; someone from our office will call you to request your address and payment information. If you choose not to prepay, you will not receive a call from our office; your order will be placed on hold for 24 hours.

Enter Supplement Reorder Information Here

Will you be picking up these supplements or do you want them shipped?
If you selected ship above and all of the items you need are not in stock, do you want to wait for everything to come in, or should we ship what we have now?
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