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Clinician Product Order

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Order

Please note: For MindX Blood Tests, ordering clinicians must be able to order laboratory tests and prescribe medications. For SXPrevent, licensed therapists and counselors are able to order it as well.

I would like to prescribe the MindX Blood Test:

Download Prescription Form

I am interested in information about the following MindX Blood Test Reports:

Mood (Depression/Bipolar)

Anxiety

Pain

Stress (PTSD)

Suicidality Risk

Memory (Alzheimer's)

Longevity

I would like to order SXPrevent

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I am interested in information about SXPrevent

Clinician Info

First Name*

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Last Name*

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Credentials*

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Practice/Organization Name*

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NPI#

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Specialty*

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How did you hear about us?*

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Address Info

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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Email Address*

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Email Address (confirm)*

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Phone Number*

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FAX Number

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Please send me product updates and information about MindX Sciences.

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Office address: Emerging Technology CenterRoom 101351 West 10th StreetIndianapolis, IN, 46202
Phone number: +1.317.220.8590
Fax number: +1.317.663.2177
Email: info@mindxsciences.com