Retail Customer Order Form


  1. For those who want to order by check or money order, please:
    • Complete and print this form.
    • Shipping & Handling fees are non-refunable, so please check the accuracy of your shipping information.
    • Make your check or money order out to NeuroGenesis
    • and mail the completed form and check or money order to:
      120 Park Avenue
      League City, TX 77573
      ATTN: Order Dept.
    • Your order will be shipped within 24 hours of our receiving it. We will ship USPS Priority mail.
  2. Those wanting to order with a credit card number, please click the Buy Now at the top of this website and proceed as instructed.
Customer ID:
(if returning customer)
Shipping Address:
City/State/Zip: ,      
E-mail address:

Product Number of Bottles Cost
NeuBecalm'd @ $37.50
NeuBecalm'd Chewables @ $35.50
NeuRecover @ $69.95
NeuRelieve @ $62.75
NeuReplenish @ $69.95
NeuSlim @ $69.95
The Combo @ $67.95

Help Center Guide
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The content of this web page is not to be considered
medical advice. To obtain medical advice, please see your
physician or health care professional.

These statements have not been evaluated by the
Food and Drug Administration. This product is not intended
to diagnose, treat, cure, mitigate or prevent any disease.

IMPORTANT: Nutritional supplements work best in conjunction with a healthy diet. Optimal health does not happen overnight, but requires a building process. Please be faithful to yourself and to your body by taking NGI products on a regular, on-going basis.