Weigh to Wellness Product Order Form

Purchase Instructions
 

Please place your order 24 hours in advance of when you plan to pick it up at the Weigh to Wellness office (245 Cherry Street SE, Suite 104, Grand Rapids, MI 49503  Map).

Hours available for product pickup are Monday - Thursday, 8 a.m. - 4:30 p.m. Or, you can pick up your order at your next scheduled appointment.

Name:

Date:

I will be picking up my order on:

Pudding/Shake (7svg/box)

Chocolate:

Chocolate Mint:

Mocha:

Vanilla:

Ready to Drink Chocolate-Individual:

Ready to Drink Chocolate-3 Pack:

Hot/Cold Drinks (7svg/bx)

Vanilla Cappuccino:

Hot Chocolate:

Peach Tea:

Soups (7 svg/bx)

Creamy Chicken:

Creamy Tomato:

Cream of Broccoli:

Beef Bouillon:

Corn Chowder:

Tex-Mex Chili:

Smoothies/Fruit Drinks (7 svg/bx)

Berry Creme:

Strawberry Creme:

Fruit Drinks- variety pack:

Gelatin (7 svg/bx)

Raspberry:

Strawberry Banana:

Cherry:

Oatmeal (7svg/bx)

Maple n Brown Sugar:

Apple n Cinnamon:

High Protein Cereal (5 svg/bx)

Honey Nut:

Cinnamon Vanilla:

Pancakes (7svg/box)

Pancakes:

Peanut Butter (30svg/pkg)

Peanut Butter Powder:

Crisp n Crunch Bars (7 svg/bx)

Peanut Bar with Chocolate Topping:

Peanut Bar with Peanut Butter Topping:

Cinnamon Bar:

Fudge Graham Bar:

Lemon Meringue Bar:

Peppermint Cocoa Crunch Bar:

Chewy Protein Bars (7 svg/bx)

Caramel Crunch Bar:

Double Peanut Butter Bar:

Chocolate Covered Peanut Butter Bar:

Strawberry Cheesecake Bar:

Caramel Brownie Bar:

Chocolate Almond Bar:

Dark Chocolate Smore Bar:

Lemon Breakfast Squares:

Snacks (1 svg/bag)

Taco Protein Bites:

White Cheddar Protein Bites:

S & V Chips:

BBQ Chips:

Shelf Stable Entrees (1 svg each) *NOT FOR VLCD PATIENTS*

Pot Roast:

Turkey Chili:

Spaghetti w/ Meatballs:

Five Bean Casserole:

Beef & Bean Enchilada:

Beef Stroganoff:

Vegetable Lasagna:

Pasta Fagioli:

Chicken Pasta Parmesan:

Spicy Chicken Oriental:

Beef Stew:

Taxable Items (amounts below include tax)

Food Scale:

Calorie King Book:

Food & Exercise Journal:

Water Bottle:

Omron Pedometer:

Shaker Cup (/50/each):

Quick Shaker Cup Complete Book of Food Counts:

ProOmega w/ Vit. D-Qty 60/bottle:

Complete Book of Food Counts: