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Chronic Pain Treatment Rebate Application Form

To claim your 50% off discount: Simply fill out this form and upload a copy of your pension card, and we will send you a 50% off code to use at checkout.

Personal Information

Pension Card Details
Upload File

Chronic Pain Condition:

  • Please briefly describe your chronic pain condition(s):

Product Selection:

  • Please select the chronic pain treatments you are interested in:

Additional Terms:
I agree to the maximum rebate of 50% off one product purchase per month per person.
I understand and agree to the 100% money-back guarantee if any of the purchased products do not provide relief from my chronic pain.

Additional Comments or Questions:
Is there anything else you would like us to know or any questions you have about our products or the rebate offer?

Thanks for submitting!

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