B-12 TRACKER / LIPO MINO

First Name *

Last Name *

NUMBER OF INJECTIONS PAID FOR

LIPOSTAT - ASK ABOUT SULFA ALLERGY! BEST FOR: ENERGY + FAT BURN + METABOLISM

LIPOMINO- NO CONTRAINDICATIONS BEST FOR: ENERGY + FAT BURN

MICC - NO CONTRAINDICATIONS BEST FOR: ENERGY

INJECTION 1 DOSE

DATE

COMPLETE

YES

note

INJECTION 2 DOSE

COMPLETE

YES

DATE

note

INJECTION 3 DOSE

COMPLETE

YES

DATE

note

INJECTION 4 DOSE

COMPLETE

YES

DATE

note

INJECTION 5 DOSE

COMPLETE

YES

DATE

note

INJECTION 6 DOSE

COMPLETE

YES

DATE

note

INJECTION 7 DOSE

COMPLETE

YES

DATE

note

INJECTION 8 DOSE

COMPLETE

YES

DATE

note

INJECTION 9 DOSE

COMPLETE

YES

DATE

note

INJECTION 10 DOSE

COMPLETE

YES

DATE

note

INJECTION 11 DOSE

COMPLETE

YES

DATE

note

INJECTION 12 DOSE

COMPLETE

YES

DATE

note

INJECTION 13 DOSE

COMPLETE

YES

DATE

note

INJECTION 14 DOSE

COMPLETE

YES

DATE

note

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