Epilepsy Report Order Form

TO ORDER
Print Form
Mail or Fax to:
MINCEP Epilepsy Care
5775 Wayzata Blvd.
Minneapolis, MN 55416

(952) 525-1560 Fax
(952) 525-4507 Phone

Written for physicians by nationally recognized experts in the field of epilepsy, the MINCEP Epilepsy Reports summarize large amounts of complex clinical material in a convenient format useful for those in clinical practice. These Reports are produced by MINCEP Epilepsy Care to encourage early clinical intervention in the treatment of epilepsy. Patients and their families often request them for the most up to date information on diagnosis, treatment and antiepileptic medications. Conveniently 3-hole punched for insertion into a binder, the Epilepsy Reports are suitable for your patient waiting room or as an addition to your reference library.

ORDER BY FAX OR BY MAIL TO BEGIN YOUR BIMONTHLY
SUBSCRIPTION

______________________________________________________________
Name                                                                                 Profession

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Institution/Clinic and Address                                                              

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City/State/Zip                                                         Daytime Telephone

 

_ ENCLOSED IS A CHECK FOR THE FULL AMOUNT __$35

_ PLEASE BILL MY CREDIT CARD                         __$35

  MC/VISA___________________________________EXP.___________ 

AUTHORIZED SIGNATURE____________________________________

MAIL TO: 
MINCEP Epilepsy Care
5775 Wayzata Boulevard • Minneapolis, MN 55416
FAX TO: 952-525-1560
 www.mincep.com