Customer # _____________ Date_ _______________ Phone _____________________ Name
______________________________________________________________
Address ______________________________________________________________
Office Hours: Monday-Thursday, 9am to 6pm and Friday, 9am to 5pm, EST.
PATIENT DIRECT ORDER FORM
Dr. Frederick Swendsen D.C.
Patient Number: SWE 042
To place an order, please call: 800.634.6342
SAVE
23% Off
Suggested
Retail
UPC & PRODUCT SIZE SUGG. LESS QUAN. TOTAL
PROD # RETAIL 23%
DIGESTIVE
Digestive Enzymes Clinical Strength
90 45.95
Gluten & Dairy Ultra Shield™ Enzymes 60 29.95
Plant Enzymes
90 32.95
Plant Enzymes
180 58.95
Flora 5-14™ Complete Care
60 19.95
Flora 20-14™ Ultra Strength
60 39.95
Flora 50-14™ Clinical Strength
30 35.95
Flora 50-14™ Clinical Strength
60 65.95
Flora 200-14™ 7 Day Intensive *NEW* 7
29.95
FOUNDATIONAL
40008 Baby & Me™ Trimester I & II
120 45.95
40009 Baby & Me™ Trimester III & Post
120 47.95
40077 Food Multi II™ without Fe, I & Vit. K
90 39.95
40078 Food Multi II™ without Fe, I & Vit. K
180 68.95
40061 Food Multi III™ BioMax
90 35.95
40062 Food Multi III™ BioMax
180 66.95
40033 Food Multi IV™
180 79.95
40026 Kid’s Multi *NEW*
60 20.95
40136 Maximum Foods®
90 50.95
40137 Maximum Foods®
180 90.95
40046 Men’s Multi Iron Free
30 18.95
40047 Men’s Multi Iron Free
90 43.95
40049 Men Over 40™ Iron Free
90 43.95
40050 Men Over 40™ Iron Free
180 79.95
40054 Men’s One Daily Iron Free
60 31.95
40125 Men Over 40 One Daily Iron Free
60 36.95
40000 One Daily 30 19.95
40002 One Daily 90 45.95
40003 One Daily 180 84.95
40051 One Daily without Iron
30 19.95
40055 One Daily without Iron
90 45.95
40056 One Daily without Iron
180 84.95
40030 Vitamin Only
90 50.95
40043 Women’s Multi
30 18.95
40044 Women’s Multi
90 43.95
40038 Women Over 40™ 90 43.95
40041 Women Over 40™ 180 79.95
40052 Women’s One Daily
60 31.95
40124 Women Over 40™ One Daily
60 36.95
FUNCTIONAL FOODS
44003 Men’s Renewal MetaCore™
360 G 42.50
44002 Men+40 Renewal MetaCore™
360.G 42.50
44001 Women’s Renewal MetaCore™
360.G 42.50
44000 Women+40 Renewal MetaCore™
360 G 42.50
44007 Clinical MetaCore™ Berry Vanilla
454 G 45.85
44004 Clinical MetaCore™ Cacao Bean
454 G 45.85
44006 Clinical MetaCore™ Cinnamon Chai 454 G 45.85
44005 Clinical MetaCore™ Vanilla Bean
454 G 45.85
TARGETED RESPONSE
40095 Adrenal Response®
30 18.95
40096 Adrenal Response®
60 33.95
40119 Adrenal Response®
90 49.95
40104 Adrenal Response® Complete Care
30 28.95
40105 Adrenal Response® Complete Care
90 77.95
41244 Bone Response®
90 34.95
41247 Bone Response®
180 63.95
41064 Calm Response™
90 36.95
40082 Cardio Response®
60 40.95
40083 Cardio Response®
90 57.95
40126
40127
40058
40085
40129
41006
40128
40141
40140
City
______________ State ______________ Zip Code______________________
Email
______________________________________________________________
C.O.D. q
Check w/Order q
MasterCard q
VISA q
AMEX q
DISCOVER q
Account #_____________________________________ Expiration Date_____________
UPC & PRODUCT SIZE SUGG. LESS QUAN. T OTAL
PROD # RETAIL 23%
40034 Cholesterol Response®
30 27.95 21.52
35.38
40036 Cholesterol Response®
60 49.95 38.46
23.06
40070 Immunostimulant Response™
30 54.95 42.31
25.37
40071 Immunostimulant Response™
60 100.95 77.73
45.39
40138 Liver Response™
30 22.95 17.67
15.36
40139 Liver Response™
60 40.95 31.53
30.76
40064 MaitakeGold 404®
30 29.95 23.06
27.68
40065 MaitakeGold 404®
60 54.95 42.31
50.78 40092 Prostate Response®
60 31.95 24.60
23.06
40057 Skin, Hair & Nails
90 39.95 30.76
40117 Sleep Response™
60 50.95 39.23
35.38
40118 Sleep Response™
90 75.95 58.48
36.92
40106 Thyroid Response® Complete Care
30 20.95 16.13
30.76
40107 Thyroid Response® Complete Care
90 49.95 38.46
53.09
40098 Thyroid Response® Estrogen Dominance30 18.95 14.59
27.68
40099 Thyroid Response® Estrogen Dominance 6 0 31.95 24.60
51.55
40100 Thyroid Response® Estrogen Dominance 9 0 42.95 33.07
61.56
40101 Thyroid Response® Nutrient Factors
30 14.95 11.51
16.13
40102 Thyroid Response® Nutrient Factors
60 23.95 18.44
39.23
40103 Thyroid Response® Nutrient Factors
90 31.95 24.60
70.03
40115 Vision Response™
60 52.95 40.77
14.59
40116 Vision Response™
90 76.95 59.25
WHOLE FOOD MINERALS
33.84
33.84
40020 Balanced Minerals
90 30.95 23.83
61.56
40021 Balanced Minerals
180 57.95 44.62
24.60
40072 Calcium
90 21.95 16.90
28.45
40022 Calcium
180 39.95 30.76
15.36
40059 Calcium, Magnesium & Potassium
90 34.95 26.91
35.38
40023 GTF Chromium
90 22.95 17.67
65.41
40010 Iron Response™
90 27.95 21.52
15.36
40024 Magnesium
90 25.95 19.98
35.38
40025 Magnesium
180 47.95 36.92
65.41
40027 Selenium
90 20.95 16.13
39.23
40028 Zinc
90 21.95 16.90
WHOLE FOOD VITAMINS & ANTIOXIDANTS
14.59
33.84
40063 Antioxidants
90 42.95 33.07
33.84
40011 B Complex
90 32.95 25.37
61.56
40012 B Complex
180 58.95 45.39
24.60
40075 Complete 8™ Vitamin E 400 IU
30 37.95 29.22
28.45
40076 Complete 8™ Vitamin E 400 IU
60 68.95 53.09
42010 E & Selenium
90 32.95 25.37
32.73
42011 E & Selenium
180 58.95 45.39
25.50
40013 Folate, B6 & B12
90 24.95 19.21
32.73
40133 Kid’s Vitamin D Mini Tabs 400 IU
60 14.95 11.51
32.73
40134 Kid’s Vitamin D Mini Tabs 400 IU
90 21.95 16.90
35.30 40135 Kid’s Vitamin D Mini Tabs 400 IU
180 35.95 27.68
35.30
40109 Quercetin
60 24.95 19.21
35.30
40110 Quercetin
90 34.95 26.91
35.30
40111 Quercetin
180 61.95 47.70
40060 Vitamin C-250
60 23.95 18.44
14.59
40069 Vitamin C-400
30 15.95 12.28
26.14
40016 Vitamin C-400
90 34.95 26.91
38.46
40017 Vitamin C-400
180 63.95 49.24
22.29
40122 Vitamin D-3 1,000 IU
60 18.95 14.59
60.02 40123 Vitamin D-3 1,000 IU
90 26.95 20.75
26.91
40130 Vitamin D-3 2,000 IU
60 26.95 20.75
49.24
40131 Vitamin D-3 2,000 IU
90 37.95 29.22
28.45
40132 Vitamin D-3 2,000 IU
180 73.95 56.94
31.53
40029 Wild Blueberry
60 21.95 16.90
44.62
effective December 2010
Professional Division, 8 Bowers Road, Derry, NH 03038
www.innateresponse.com
Fax 603.437.0796 • Phone 1.800.634.6342 or 603.216.0899
* Please note: These products are distributed exclusively through licensed healthcare practitioners only.
Return Policy:
1. Products returned within 4 months of ordering will receive 100% credit of the purchase price, 4-6 months 50%, 6-9 months 25%.
2. No credit will be issued for products returned after 9 months from the order date.
3. Please report any damaged bottles you receive immediately so we can arrange for prompt credit or replacement and for a pick-up.
Shipping and Payment Policy:
All orders under $150 will be charged a $6.50 shipping charge. All COD orders will be charged a $9.00 handling fee. All orders (with the
exception of Alaska and Hawaii) are shipped out FedEx Ground, unless otherwise specified.
Customer will be responsible to pay for additional charges to ship orders by expedited courier or to countries outside the U.S.
All items to be returned do require pre-authorization before shipping back.
Payments: We accept: Visa, Mastercard, American Express, Discover, COD and Checks. Net 30 day terms are available, please request a
credit application.
Note: Please make checks payable to BioSan Laboratories, Inc. and send payment to 8 Bowers Road, Derry NH 03038. Include your
customer account number and/or phone number with your payment. Please allow 24 hours to process all incoming orders.
Prices subject to change without notice. No minimum order per item. All orders are processed within 24 hours.
NEW!
Flora 200-14™ 7 Day Intensive
200 billion viable cells of 14 probiotic strains
Repopulate Flora in 7 Days!
Flora 200-14 is an intensive probiotic program designed
to repopulate flora populations effectively in seven days. This formula is a complete synergistic union of 200
billion cells from 14 non-competing bacterial strains. Flora 200-14 provides effective higher potencies of
bifidobacteria strains and balanced additions of lactobacilli strains including inflammation support from the
well-documented Lactobacillus salivarius strain. In total, all 14 strains have been clinically researched as the best
combination of probiotic strains to effectively repopulate the transient and resident probiotic populations of the
complete digestive tract and mucosal membranes. With 200 billion cells and 14 strains, Flora 200-14 will provide
immediate support for detoxification programs, digestive issues, compromised immunity and inflammatory
conditions.
• Clinical strength – professional use only
• Easy to administer vegetarian capsule
• Exceptionally pure
• Nothing artificial or synthetic
• Suitable for vegetarians
• Tested free of gluten, dairy and soy
• Selected only from viable strains naturally present in the human
intestinal tract
Clinically Researched
INDUSTRY FIRST