B12 California Patient Outreach

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* 1. Your Name

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* 2. Age of Patient

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* 3. City, State

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* 4. Do you want your/your child’s name to remain anonymous?

Yes

No

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* 5. Have you ever had difficulty obtaining B12 medication (sterile injection)? If yes, please feel free to add detail. For example, I have had to go to 3 different pharmacies because the other 2 stopped shipping into California.

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* 6. What health benefits or improvements have you/your child experienced by using Lee Silsby’s B12 medication? We would love to hear specific examples of how B12 improved functioning or added to the quality of your life. Our pharmacy is always moved by these testimonies and humbled to support your critical care.

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* 7. Are you willing to share a photo to personalize your patient testimony?

Yes

No