Fill out the Patient Information section and place a check mark next to the product you wish to order. Download here
Send the sheet to your doctor.
Instruct your Dr.’s office to fill out the rest of the sheet and fax or email it to ICON Health Science.
As soon as we receive the form, we will contact you to process your discounted order.
Alternatively, you can purchase RELIADERM ADVANCED PAIN RELIEF CREAM directly from this website.