These forms are available to established patients:

1.  Environmental Control (products which can help reduce the amount of chemicals you are exposed to in every day life)

2.  Instructions for “First Aid Measures” to overcome allergic reactions, etc. 3.    Instructions for “First Aid Kit for Respiratory Conditions.”

4.  Allergy Extract Order Form

5.  Credit Card Authorization Form (to print out and fax or mail back in to Center--this form is NOT interactive online.)

6.  Referral Form:  If any person you refer to our Center lists your name on this form as their referral source, you will receive a $25.00 credit on your patient account!  This is our way of saying Thank You to our patients for sharing your confidence in us with your friends and loved ones.
Click here to send an order to Orders@coem.com
Please note that this e-mail is ONLY for ORDERS of our extracts, nutritional supplements, or other COEM products.  For Questions about how to use COEM products or about your treatment plan, see below.

Coming Soon!:  Click here to see our list of nutritional supplements and products that we use in our treatment programs at The Center.  We accept orders from patients who have a current Patient Account in good standing.  Patients who order on line must have had a consultation with one of our doctors some time within the last 12 months.  Thank you for your understanding and cooperation in this matter.
For questions, please call our office at (843) 572-1600, or click here to access the e-mail addresses for all staff members.
Click here to read more about our available Programs and Treatment Modalities.

Disclaimer:
All material provided on the Center for Occupational & Environmental Medicine web site is for educational purposes only. Access to the web site does not create a doctor-patient relationship nor should the information contained on the web site be considered specific medical advice for any person, patient and/or medical condition. Consult a physician regarding the application of any opinions or recommendations from this website, for any symptom or medical condition. Dr. Lieberman specifically disclaims any liability, loss or risk, personal or otherwise, that is or may be incurred as a consequence, directly or indirectly, resulting from use or application pertaining to any of the information provided on the web site.