Order Form for Meal Replacement Products

Modified Low Calorie Diet

You can submit this form to The Center for Medical Weight Loss of Santa Fe electronically so your meal products can be ready for your next visit. Please submit this form at least one business day before your visit to make sure we have time to complete your order.

Instructions: Please order 42 items from the list below, but no more than 14 from the bars/soups/crisps list. If you require additional products, please list them in the “Additional Information” box below. Be as complete as possible. Fields marked with * are required.

* Patient Name
* Planned Pickup Date / /  (at least one business day from now)
* Planned Pickup Time :    (hour : minute am / pm)
* Best Phone Number  (for questions about your order)
* Please Choose from the Following Selection of Products
Ready-to-Drink Shakes 
Chocolate
Berry
Vanilla
Total0
Powder Shakes 
Chocolate
Berry
Vanilla
Total0
Note: No more than one bar, soup or crisp per day
Protein Bars 
Caramel Peanut Chew
Fudge Almond Coconut
Chocolate Brownie
Cinnamon Crunch
Chocolate Graham Crunch
Crispy Peanut Butter
Totally Toffee
Mixed Berry
Total0
Soups 
Chicken Soup
Tomato Soup
Total0
Crisps 
BBQ
Sour Cream & Onion
Total0
Total Products Ordered0
Additional Information
or Instructions
Please Note the Following
  1. Please place orders at least 24 hours prior to planned pickup time
  2. Orders not picked up within 24 hours of indicated pickup time will be returned to inventory
  3. Please check your items before leaving our office to make sure your order is correct
  4. Unfortunately we cannot offer any exchanges or returns on these products
* Test Question
 6 + 7 =
  (this helps prevent spam)