UC Santa Barbara, Mosher Hall MC #5111,
552 University Rd
Santa Barbara, CA 93106
https://SantaBarbaraNutrients.com
Info@SantaBarbaraNutrients.com

 

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Greetings, 

 

We have received your request to contact your practitioner via  

Per your consent, we will contact your practitioner on your behalf regarding the use of KetoCitra.

 

-Santa Barbara Nutrients

 

NOTE TO PRACTITIONER:

 

PRACTITIONER INFORMATION:

 

CUSTOMER CONSENT FORM:

"You have indicated your interest in taking KetoCitra and have requested Santa Barbara Nutrients to provide information to your physician as it relates to KetoCitra. By Checking this box, you are giving consent to Santa Barbara Nutrients to contact your physician via email, fax, or telephone regarding the use of KetoCitra"

 

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Signature Certificate
Document name: Customer consent
lock iconUnique Document ID: 58329dd4ff57915a67221a8575c578e5bc8a3337
Timestamp Audit
September 23, 2021 9:34 am PSTSBN Practitioners - practitioners@sbnutrients.com added by David Stagnitto - stagnitto@sbnutrients.com as a CC'd Recipient Ip: 24.213.151.4
September 23, 2021 9:43 am PSTSBN Practitioners - practitioners@sbnutrients.com added by David Stagnitto - stagnitto@sbnutrients.com as a CC'd Recipient Ip: 24.213.151.4
September 23, 2021 10:35 am PSTSBN Practitioners - practitioners@sbnutrients.com added by David Stagnitto - stagnitto@sbnutrients.com as a CC'd Recipient Ip: 24.213.151.4
September 23, 2021 2:30 pm PSTCustomer consent Uploaded by David Stagnitto - stagnitto@sbnutrients.com IP 172.101.132.135
September 24, 2021 12:54 pm PSTSBN Practitioners - practitioners@sbnutrients.com added by David Stagnitto - stagnitto@sbnutrients.com as a CC'd Recipient Ip: 24.213.151.4
September 26, 2021 9:22 pm PSTSBN Practitioners - practitioners@sbnutrients.com added by David Stagnitto - stagnitto@sbnutrients.com as a CC'd Recipient Ip: 172.101.132.135
September 26, 2021 10:52 pm PSTSBN Practitioners - practitioners@sbnutrients.com added by David Stagnitto - stagnitto@sbnutrients.com as a CC'd Recipient Ip: 172.101.132.135
September 26, 2021 10:52 pm PSTSBN Practitioners - practitioners@sbnutrients.com added by David Stagnitto - stagnitto@sbnutrients.com as a CC'd Recipient Ip: 172.101.132.135
September 27, 2021 12:28 pm PSTSBN Practitioners - practitioners@sbnutrients.com added by David Stagnitto - stagnitto@sbnutrients.com as a CC'd Recipient Ip: 24.213.151.4
September 28, 2021 9:00 am PSTSBN Practitioners - practitioners@sbnutrients.com added by David Stagnitto - stagnitto@sbnutrients.com as a CC'd Recipient Ip: 24.213.151.4
September 28, 2021 9:02 am PSTSBN Practitioners - practitioners@sbnutrients.com added by David Stagnitto - stagnitto@sbnutrients.com as a CC'd Recipient Ip: 24.213.151.4
September 29, 2021 2:54 pm PSTSBN Practitioners - practitioners@sbnutrients.com added by David Stagnitto - stagnitto@sbnutrients.com as a CC'd Recipient Ip: 172.101.132.135
September 29, 2021 2:55 pm PSTSBN Practitioners - practitioners@sbnutrients.com added by David Stagnitto - stagnitto@sbnutrients.com as a CC'd Recipient Ip: 172.101.132.135
October 1, 2021 1:28 pm PSTSBN Practitioners - practitioners@sbnutrients.com added by David Stagnitto - stagnitto@sbnutrients.com as a CC'd Recipient Ip: 24.213.151.4
October 1, 2021 1:30 pm PSTSBN Practitioners - practitioners@sbnutrients.com added by David Stagnitto - stagnitto@sbnutrients.com as a CC'd Recipient Ip: 24.213.151.4
October 2, 2021 8:49 am PSTSBN Practitioners - practitioners@sbnutrients.com added by David Stagnitto - stagnitto@sbnutrients.com as a CC'd Recipient Ip: 172.101.132.135
October 2, 2021 8:50 am PSTSBN Practitioners - practitioners@sbnutrients.com added by David Stagnitto - stagnitto@sbnutrients.com as a CC'd Recipient Ip: 172.101.132.135
October 2, 2021 8:50 am PSTSBN Practitioners - practitioners@sbnutrients.com added by David Stagnitto - stagnitto@sbnutrients.com as a CC'd Recipient Ip: 172.101.132.135