Avaloution — Order Submission

Fill this out once, live on the call with the doctor. On submit you'll be taken straight to Secure to take payment — no handoff, no waiting. Accounting is notified automatically.

Step 1

Client

New customer, or someone already in our system?

New client

First order — we'll create their record.

Existing client

Already in the CRM — pull up their info.

Pricing tier *

Step 2

Doctor & practice

First name *

Last name *

Practice name *

Email *

Phone *

Step 3

Products & quantities

Prices update with the tier you picked. PRP/PRF kits drop to bulk pricing at 15+ units automatically.

Product

Qty

Line total

⚠ Required for biologics / exosomes in this order

Medical Director name *

NPI #

Medical License #

Subtotal$0.00

Shipping & handlingTBD by accounting

Estimated total$0.00

Step 4

Fulfillment

How and when does this order ship?

As soon as possible

Ship the whole order the moment it's ready.

By a specific date

Doctor has a patient/appointment date in mind.

Partial — split shipment

Ship some items now, hold the rest. Mark which lines hold below. Each later shipment is charged its own shipping fee.

Pending / on hold

Prepaid, no date yet. Goes to Awaiting Fulfillment — we follow up in 2 weeks.

Step 5

Billing & shipping

Billing address *

Shipping address is the same as billing

Shipping address

Invoice email

Step 6

Payment

No card details are entered here or stored in the CRM. On submit you go straight to Secure (the merchant) to run the card live.

Card on file

Charge the card already vaulted in Secure for this doctor.

New card

Capture a new card on the Secure page after submit.

The doctor authorizes this charge and storing the card for future orders. * Also text the doctor the authorization link to confirm in writing needs A2P

Step 7 — optional

Notes for accounting

All purchases are governed by the laws of the State of Florida; disputes resolved exclusively in the courts of Lee County, Florida. All sales are final.

You'll be routed to Secure to run the card. Accounting is notified the instant you submit.

Place an order