Mystique Patch Order Form

We’re Happy You’re Here

We’re so glad that you’ve decided to get healthy with the Mystique Lifestyle System at Greenville Natural Health Center. The Mystique Lifestyle Patch plus Healthy Lifestyle Seminar Series meetings equals the healthiest you YET!

Meetings

We can’t wait to see you at your first meeting! At the meeting, Dr. Marina will present a healthy living lesson and you’ll get your first month of patches, weigh in, get measured and get all your questions answered. (Note: You don’t have to attend meetings to sign up for the patches!)

Cost

Have you already purchased your first month’s patches for $75 plus tax (and $5 shipping if you need us to ship the patches to you; no shipping charge if you pick up the pack)? If so, you can also get set up for patches at the $60 (plus a low-rate shipping, no tax) rate on this form. Just indicate this information in the Billing Notes field, and we’ll set you up. After you’re set up, we’ll email you a form that explains how to change your order, billing and shipping preferences, as well as how to stop the auto ship.

Got questions?

Call us at (864) 370-1140 or email us at [email protected]. We’d love to hear from you!

Place Your Order

Your Name (required)

Your Email (required)

Phone Number (required)

Billing Authorization (required)
By filling out this form, you authorize Greenville Natural Health Center to run your credit/debit card for $75 plus tax (and $5 shipping if you need us to ship the patches to you; no shipping charge if you pick up the pack) if this is your first month of patches. If you're signing up for auto refill, you authorize us to charge you $60 (plus a low-rate shipping, no tax). We accept Visa, Mastercard and Discover.

Please give our office a call at (864) 370-1140 or email us at [email protected] if you have any questions about billing.

Note: Future months will cost only $60 (plus a low-rate shipping, no tax), and you can sign up for future months on this form.
Check if you agree.

Credit Card Number (required)

Expiration Date of Credit Card (required)

Billing Zip Code for Credit Card (required)

3-Digit Security Code for Credit Card (CID) (required)

Billing Rate (required)
Is this your first Mystique Patch order with us?
 Yes, bill me at the $75 rate. No, bill me at the $60 rate.

Billing and Shipping Address (required)
Please include your billing and shipping address.

How did you find your way to this page? (required)
We'd love to find out a bit more about you so that we can best serve you on your journey to health!
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Questions or Comments? (optional)