VIP WEIGHT LOSS PRODUCT ORDER FORM

This order form is for Monday through Saturday

Please note one week only

Please request your prescription medication and current dosage below for the week:

Product Details

Hey everyone! All orders are first-come, first-serve on the supply of flavors! Please submit your order by 5:00pm on Sunday, Thank you!

Please note: All categories are restrictive and non-restrictive.

RESTRICTIVE: Anything that you can eat or chew.

NON-RESTRICTIVE: Anything that is drinkable.

You will need 1 box of restrictive and 2 boxes of non-restrictive. (Unless you are only doing non-restrictive then your order count will be three items.)

(Please order one week only)

Food Variety

Restrictive

Apples and Cinnamon Oatmeal (0 available)
Bacon & Cheese Egg Omelet (10 available)
Mac/Cheese (0 available)
Cheddar Cheese Curls (Pack of 7) (0 available)

Mug Cake Variety

Restrictive

Blueberry Mug Cake (6 available)
Chocolate Caramel Mug Cake (30 available)

Food Variety

Non-Restrictive

Bacon Cheese Soup (27 available)
Broccoli Cheddar Soup (18 available)
Chicken Tortilla Soup (29 available)
Raspberry Gelatin (4 available)

Protein Crisps

Restrictive

Barbeque Protein Crisps (0 available)
Ranch Crisps (0 available)
Pizza Krinkles (10 available)

Which kind of salad dressing would you like?

You may choose one or both of the flavors below:

Honey Mustard (31 available)
Balsamic Vinaigrette (29 available)

Amino Pills

1 Month of Amino's

Red, White and Blue (6 available)

Vitamins

1 Month of Vitamins

KLB5 (3 available)
CLA (6 available)
Simple Trim (3 available)
Multi (36 available)

Injections

1 per week

LIPO SHOT
B-COMPLEX

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VIP WEIGHT LOSS PRODUCT ORDER FORM

Thank you for submitting your order!