Clinician Order - MindX Sciences

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A doctor (or other prescriber) can prescribe the MindX One™ Blood Testing. Any clinician (including therapists) can order Life x Improve Digital Testing. Please fill out the forms below and FAX to +1.317.663.2177 or email to info@mindxsciences.com.

I would like to prescribe MindX One™ Blood Testing for my patient(s):

Download Prescription Form

I would like to order Life x Improve™ for my patient(s):

Download Order Form

Clinician Request for Information

First Name*

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Last Name*

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Credentials*

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Specialty*

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Phone Number*

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Email Address

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NPI#

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FAX Number

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How did you hear about us?

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Address Info

Practice/Organization Name

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Address 1

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Address 2

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City

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State

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Postal Code

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FAX Number

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Please send me information about MindX Sciences and product updates.

I consent to MindX Sciences storing the submitted data and contacting me.

Please note: For MindX One™ Blood Tests, prescribing clinicians must be able to order laboratory tests and prescribe medications. Life x Improve can also be sent to licensed therapists and counselors.