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Tangible Boost: Additional Information Required

If You Have a Prescription on File:

• Enter your Date of Birth
• Enter your Practitioner’s Name or Rx Code
• Your order is approved automatically

If You Do Not Have a Prescription on File:

• Enter your Date of Birth
• Provide as much practitioner information as possible. Complete information ensures timely processing
• We will contact your practitioner to obtain your prescription before shipping

* Date of Birth (MM/DD/YYYY) Please enter a date of birth

* Practitioner Rx Code (If You Don't Have A Code Enter Your Practitioner’s Name) Please enter a Rx Code or Name This field is required

Practitioner's Phone Number Please enter a valid phone number This field is NOT required

Practitioner's Email Please enter a valid email address This field is NOT required