Physician Recommended Nutriceuticals
       
Doctor Information
Doctor *
Invalid Partner Code
Patient Information
First Name*
Last Name*
Primary Number (Mobile Preferred)*
Secondary Number
Email  
  * Please provide both email and phone - this gives the patient more options to establish home delivery to suit their preference

  Preferred Language*
 
Recommendation Made for...*
  * Check box to confirm that patient has consented to having PRN contact them by phone, email, and/or text to follow-up on product recommendations, and understands that while PRN will protect the privacy and security of their information, that is also dependent on the carrier's privacy and security measures, which are beyond PRN's control.
Recommendation




  Product *

Bottles Sold (excluding sample size bottles) *



  2nd Product

Bottles Sold (2nd Product) (excluding sample size bottles)



Product *  


 
Doctor Notes
 
 
 

Simple Instructions

Click Submit after completing the required fields.
A PRN product advisor will contact your patient within 24-48 hours to answer remaining questions and assist in home-delivery set up.

PRN products
To place a wholesale order for your practice, please contact wholesale@prnomegahealth.com


PRN USA - Physician Recommended Nutriceuticals
960 Harvest Drive, Building B, Suite B205
Blue Bell, PA 19422
Customer Service: 800.900.2303
www.prnomegahealth.com