I authorize Derek Ford to receive a copy of my wishlist/cart and contact me via phone, text or email for a consultation or to answer any further questions I have. Any associated call may be recorded for quality and training purposes. The form should not be used to transmit private health information, and we disclaim all warranties with respect to the privacy and confidentiality of any information submitted through this form.

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I agree to the TERMS AND CONDITIONS & PRIVACY POLICY and to receive emails from the doctor selected with information on my wishlist or cart.