Dietary Supplements

Vitamins, Minerals, Herbs and Dietary Supplements are made available ONLY to patients who are currently under the care of Preventive Medicine Group. Please indicate the supplements you would like to purchase and your preferred payment method.

First Name	Last Name	Street Address
City	State	Zip Code
Daytime Phone Number	Evening Phone Number	E-mail Address
Method of Payment:
At the Office	Send Check	Credit Card
Card Holder's Name	Credit Card Number	Exp Date

Please indicate which supplement(s) you would like to purchase by checking the appropriate box(es). Thank You.

GENERAL NUTRITION: Basic Nutrients without copper $27.00 Basic Nutrients with copper $27.00 Chelation Multiple Vitamin Q.S. $17.50 Vitamin A, 25,000 IU $8.00 B Complex, 50 mg $11.00 Vitamin B6, 250 mg $10.00 Vitamin C, 1000 mg tabs $26.00 Vitamin C, Buffered powder $22.50 Vitamin C, Ester 500 mg $16.00 Vitamin C w/Bioflavonoids $10.00	GENERAL NUTRITION: Vitamin E, 400 IU $17.00 Magnesium Citrate 140 mg $8.00 Magnesium Glycinate 1000 mg $19.50 Calcium Citrate 250 mg $11.50 Calcium/Magnesium $14.00 Chromium picolinate $11.00 Zinc 15 mg $8.00 Copper 2 mg $10.00 Calcium Carbonate $11.00
CARDIOVASCULAR: Co Q 10 25 mg $19.00 Co Q 10 100 mg $28.00 Niasafe 600 $17.00 L-Taurine $9.00 Cholestin $19.00 Carditone $24.00 Cardiem $25.00 Varicosin $22.00	INFLAMMATORY/RHEUMATOID: Magnesium Malic $25.00 Inflazyme (Bromelain) $20.00 Glucosamine Sulfate $28.00 Evening Primrose Oil $19.00 Marine Lipids, 1000 mg $10.50 Traumagen $23.00 AR-ENCAP $29.00
NEUROLOGIC: 5-HTP $24.00 Memoractiv $50.00 Melatonin $7.50 Valerian $13.00 Kava-55 $21.00 Gingko 40 mg $22.00 Gingko 60 mg $35.00 St. John’s Wort $16.00	GASTROINTESTINAL: Psyllium $16.00 Digestase $19.50 SF 734 $15.00 Tricycline $29.00 Biocidin $39.00 GI Flora $8.00 Vital 10 (High potency) $24.00 Rhizinate $15.00 Permeability Factors $34.00 L-Glutamine $12.00
IMMUNE SUPPORT/ONCOLOGIC: IP-6 $53.00 Immunotone $16.00 Co Q 10 $28.00 Thymuril $20.00 ProGreens Powder $35.00 Progreens Caps $26.00 Myco-Immune $27.00 Calcium-D Glucarate $15.00 Arabinex $23.00 Maitake-Gold $75.00 Indoplex $28.00
METABOLIC: Isocort $24.00 Adrenplus $16.50 Hypoglycemic Formula $16.00 Diabinil $45.00	TOPICALS: Licrogel $6.50 Arnica Ointment $8.00
DETOXIFICATION/ALLERGY: Lipoic Acid $22.00 DMSA 500 mg $5.00 Milk Thistle $26.00 Quercitin $16.00 Ephedra $16.50 UltraClear $57.00 UltraClear Plus $60.00 UltraClear Sustain $52.00	ANTIFUNGALS: Prolive $29.00 Micropryl $15.50 Paramicrocidin $19.90
HORMONALS: OsCap Plus $31.00 Ipriflavone $25.00 OSTA B3 $31.00 DHEA 25 mg $18.00 DHEA 5 mg $6.00 Saw Palmetto $36.00 Femtone $17.00	EPD: EPD Multiple $23.00 EPD Trace Minerals $9.00 Folic Acid 5 mg $11.00
ANTIOXIDANTS: Occudyne $34.25 AntiOx $19.00 Planti-Oxidants $21.00 Lutein $20.00 OPC'S (Masquelier's) $49.00	MISCELLANEOUS: Transfer Factor $49.00 Ipriflavone $25.00 Coriolus(PSP) Versicolor $49.00

Please use the space below for any questions or comments you may have.

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Before you submit any information, please remember: you need not give us any information. If you do give us information, you do not need to fill in all the fields. Any information that you do give will never knowingly be released until authorized to do so by you.

Please click the submit button.

Thank you.

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Steven C. Halbert M.D.
1442 Ashbourne Road · Wyncote, PA 19095 · 215-886-7842 · 215-887-1921 (fax)

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