CONSCIENCE ET SANTE
vos indicateurs

 

 BON DE COMMANDE

NAME or pseudo:

email:

 

SEX (W or M):

 

 

W M

 

Date birth:

 

 

Hour birth :

or between what hours or :
indicate "front" or "after" 21 hours::

 

 

City or born country:
(for evaluation)

 

 

Region or born state:
(for evaluation)

 

 

Ref. or name of the command:

 

 

Other ref:

 

 

Others precisions:

In error; to begin again everything : ( you can also rectify line by line )

To click on and your coordinates will be transferred in your mail.
In your mail: please , do not forget to click on "Send".

 

YOUR CHOICE OF SENDING AND ANSWER

SENDING AND ANSWER BY INTERNET
Please, send your possible payment by letter
at the address below

SENDING BY INTERNET OR BY LETTER
AND ANSWER BY LETTER
send your possible payment by letter to the address below.
You can also print this page or copy out it and send it
to the address below with your payment.
FOR A FREE ANALYSIS with answer by letter:
please, join an envelope stamped at your address, thank you.
( check in M.Sterlay's order )

RETURN PAGE 1

EXAMPLE OF EVALUATION

BIOCODES 58 Avenue Jean Jaurès 92190 MEUDON