Order summary

FM Checkup

(no applicable CPT code)

1 x $750.00

$750.00

1

NOTES: Limited to one purchase per year.

If you live outside of the US we are unable to assist you at this time and your order will be immediately refunded.

Subtotal

$750.00

Order total

$750.00

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Patient Information

* First Name

* Last Name

* Address - Line 1

Address - Line 2

* City

State

* Country

* Zip Code

* Phone Number

* Email Address

Credit Card Type

Credit Card Number

Exp Month

Exp Year

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