Product Order - MindX Sciences

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For Consumers/Patients

Life x Mind® Self-Assessment

Information About MindX One™ Blood Tests

Download Testing Information

For Clinicians

A doctor (or other prescriber) can prescribe the MindX One™ Blood Testing. Please download and fill out the prescription form below and upload it back securely, or 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):

Fill Prescription Form Online

Download Prescription Form

Upload Filled Prescription 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.