Natural Wellness Center
1110 W. Evans St
Florence SC 29501
843-669-2295
Patient Consent Form
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Date:
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Practitioner Name:
Practitioner Signature Date:
Practitioner IP Address:
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Personal Note
Hey, I have been using OptiMantra in our practice and would like to invite you to try it for your practice. As part of this referral, you will receive a 10% discount on the subscription fee. You can visit https://www.optimantra.com, call 866-868-5070 or just Reply All to this email with a preferred date and time for a demo. Thanks!
You (Referrer) will get a $150 gift card per sign-up [Effective 12/15/2021]