Total Wellness Solutions

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Description	Buy Two Get One Sales Form - Piezo Shockwave Treatment Sales Form
Buy 2 Shockwave, get one Shockwave FREE*
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I authorize Total Wellness Solutions to debit the account listed hereon $230.00, & agree to perform the issuer obligations. I affirm that the information entered on this form is true and correct and further declare that I have read, understand and accept Total Wellness Solutions Terms as referenced in the [Terms of Use] link below.

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Total Wellness Solutions
5252 Roswell Rd Suite 103 Atlanta, GA 30342
(770) 936-9707

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