Order

Order details

Please complete the form below and await instructions for payment. Payment will not be requested until your treatment has been prepared and ready to post. Upon receipt of payment, please allow seven to ten working days for your package to arrive.

Further contact details and instructions will be provided with your remedies. For any further questions either telephone or email contact@zentaqft.com

A concessionary price of £25 is available for people who are in receipt of DSS sickness benefits, jobseekers allowance or the low income equivalent. Please check box below (proof of income required)

First name

Last name

Address

Address (continued)

Town/City

County

Country

Postcode

Daytime telephone

Mobile telephone

E-mail address

Date of Birth

Time of Birth

Town & Country of Birth

Present Health

Please provide details including any medications

(Doctors consent required if

applicable)

Subsidised price