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Current Medications and Supplements

Please read before signing

By signing below, I confirm that:

I am 18 years of age or older.
I have listed all medications and supplements I currently take, including prescriptions and over-the-counter products.
I understand these are dietary supplements, not medications. They have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.
These supplements do not replace medical care, and I will not stop or change any prescribed medication because of them.
I will notify Prime Body Solutions of any change in my medications or health status.
I will stop taking the product and contact the clinic if I experience any reaction or unexpected symptom.

My protocol will be reviewed and approved by Cody Belkoff, D.O. before it ships. If anything above is unclear, I will call the clinic at (509) 601-4700 before signing.

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By checking this box, I consent to receive non-marketing text messages from Prime Body Solutions about your orders and wellness packs. Message frequency varies, message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

By checking this box, I consent to receive marketing and promotional messages including special offers, discounts, new product updates among others, from Prime Body Solutions at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.