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1. ORDER FORM USA/International

HOME PHOTOTHERAPY ORDER FORM USA amp International 5 Pages Directions for Use 1 Read and understand the Terms and Conditions of Sale then complete each applicable section of the form 1515 Snow Valley Road 2 Have your Healthcare Professional MD or Nurse Practitioner complete Minesing ON LOL 1Y3 the Healthcare Professional Approval section OR attach a physician s d prescription for the device This is required for USA shipments only Toll Free 866 813 3357
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