Welcome to Health Connections Center&Spa

.
Please Fill Out the Following:
All Gift Certificates expire one year from Issue Date (Date Certificate was mailed or day it was given to you)
Service Wanted
Body Wrap - $100
Colonic - $95
WellesStep - $77 ($65+$12 shipping/handling)

Recipient Information
Recipient's First Name:
Recipient's Last Name:
Recipient's Phone Number:
Certificate for the amount of:
Purchaser Information
Purchaser's First Name:
Purchaser's Last Name:
Purchaser's Street Address:
Purchaser's Apartment #:
Purchaser's City:
Purchaser's State:
Purchaser's Zip Code:
Purchaser's Home Phone #:
Purchaser's Business Phone #:
Purchaser's e-mail address:
Credit Card Information (Visa or Mastercard only, please)
Visa
Mastercard
Credit Card Number:
Expiration date:
.Issued to Address Information
Gift Certificate can be sent either through e-mail or regular (snail) mail. Please make your choice by filling out the appropriate blank spaces.
E-MAIL
Recipient's E-mail Address:
OR
REGULAR (SNAIL) MAIL
.
Recipient's Street Address:
Recipient's Apartment #:
Recipient's City:
Recipient's State:
Recipient's Zip Code:
Recipient's Home Phone:
Recipient's Business Phone:
Recipient's E-mail Address:
Security Code:

After you submit your order, you should come to a white confirmation page listing your order. If you do not, please e-mail us at info@healthconnectionscenter.com
Use your browser's back button to return to this site.

You will receive a online receipt when your credit card is confirmed. Please allow a day for confirmation.

This form is not a valid certificate but an online order form. You or your recipient has the option to receive your gift certificate in the mail (see above).

MIND BODY SPIRIT EXPO
October 23-25

REQUEST APPOINTMENT
for Health Connections
Services

MIND BODY SPIRIT EXPO October 23-25

REQUEST APPOINTMENT for Health Connections Services

MIND BODY SPIRIT EXPO
October 23-25

REQUEST APPOINTMENT
for Health Connections
Services