Vermont Natural Family Medicine PLC

I have opted and asked to have my prepaid supplements placed in the after-hours bin, on my own accord, for pick up at a time after the office is closed. *

First Name

Last Name

I understand that I do this at my own risk and that Vermont Natural Family Medicine PLC is not financially responsible for any lost or stolen supplements from the after-hours bin. *

Click here to acknowledge that you agree to above.

Date *

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