Weight Management: OPTIFAST® - Online Orders

This form is intended for use only by current patients of the Weight Management Center in Winston-Salem, NC.

Please enter the amount of each product you would like to order; this should be based on an individual serving (i.e., 1 packet instead of 1 box).

You will need to order 7 days worth of product and must weigh-in at the Weight Management Center to pick up your product.

All product orders should be checked by the client as we cannot exchange product once it leaves the Weight Management Center Nutrition Shop

If you prefer, you may also print out the order form and bring it with you. [PDF] You may also take this opportunity to print the Optifast Weekly Clinic Visit Questionnaire.

 

By Design OPTIFAST® Product Order Form
Patient Name
Patient Email
 
OPTIFAST 800- Ready to drink ($3.50 each)
Chocolate
Vanilla
Strawberry
 
OPTIFAST 800- Powder ($2.85 each)
Chocolate
Vanilla
Strawberry
 
OPTIFAST 800- Soup ($3.50 each)
Chicken
Garden Tomato
 
OPTIFAST HP- Powder ($3.50 each)
Chocolate
Vanilla
 
OPTIFAST 800- Bar ($4.25 each)
Chocolate
Berry Crunch
Chocolate Peanut Butter Crunch
   
Please tell us when you will be picking up your order.  

 

  

(Please click the Submit Form button only once.)

 

Quick Reference

Weight Management Center

336-716-6099

Hours
Mon - Fri, 8:30 to 4:30
Find us at:
Medical Plaza - Country Club
4614 Country Club Road
Winston-Salem, NC 27104
Ways to Give
USNWR 2013-2014Magnet Hospital RecognitionConsumer Choice2014 Best DoctorsJoint Commission Report

Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.