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DUTCH - Cycle Mapping - US
Secure Enrollment Form

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With love, health and Joy,

Dr. Ritamarie

Products Price Quantity Total

Products		Price	Quantity	Total
Lab Testing: Precision Analytical - DUTCH - Cycle Mapping - US " The DUTCH Cycle Mapping™ test maps the patterns of progesterone and estrogen throughout the menstrual cycle. These patterns help characterize and analyze each phase of the menstrual cycle. This test cannot be ordered for patients under 12 years of	$400.00	Update	$400.00
Subtotal			$400.00

Lab Testing: Precision Analytical - DUTCH - Cycle Mapping - US

" The DUTCH Cycle Mapping™ test maps the patterns of progesterone and estrogen throughout the menstrual cycle. These patterns help characterize and analyze each phase of the menstrual cycle. This test cannot be ordered for patients under 12 years of

$400.00

Update

$400.00

Subtotal $400.00

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Order Summary
Subtotal	$400.00
Order total	$400.00
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I authorize Dr. Ritamarie LLC to charge me for the order total listed above and agree to remit a payment to Dr Ritamarie LLC. I further affirm that the name and personal information provided on this form are true and correct. I further declare that I have read, understand and accept Dr. Ritamarie LLC's business terms as follows.

The products and services to be purchased in this transaction are owned solely by Dr Ritamarie, LLC and can only be used by the purchaser for his/her own use and education. These products and services cannot be used for any other purpose, including, but not limited to: resale, posting on web or social media sites, licensing or any commercial transaction without the written consent of Dr Ritamarie, LLC.

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