Preferred date to receive order (please choose a Thursday, we ship once a week on Wednesdays, via FedEx Next Day)

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Name *

First Name

Last Name

Shipping address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone number *

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Acknowledgements *

I understand the the cost for overnight shipping via FedEx on dry ice is a $350 flat fee to any of the United States

The recipient will have a medical freezer (non-cycling, -20C or colder) or a cooler & ability to stock dry ice for long enough to preserve the product (at least 5 pounds of dry ice per 24 hours)

Donors have NOT limited allergenic foods (eg peanuts, shellfish) from their diets unless the client has contacted Probiotic Infusions for a special order

I understand and agree that these FMT products are NOT FDA approved, or licensed to prevent or treat human disease

I understand that minimum donor laboratory screening consists of the following: HIV, syphilis, viral hepatitis, H pylori, common enteric pathogens, parasites and ova, C difficile, MDRO testing, & 16SrRNA/whole genome sequencing to assess normal flora