Order Form
For Specialists Who Like To Provide Services To Arab Cash Patients

How to use this Form:

Use one Form per Order.
Type in the Form, on screen response, (fill out all applicable blanks. For others , please type "NA" not applicable)
If you make a mistake, backspace and type again, or highlight the entire box and hit "Backspace".
Press "TAB" to move between blank spaces.

I would like to order the following service;
Design a new Arabic website to describe the client's skills and procedures. Also, the new website will receive a free website hosting value $83 per year):  Sample 1
    Sample 2      Sample 3

List the client's new Arabic website and clinic at the following Arab websites:

  1. Face Cosmetic Procedures - Arabic Language Samples

  2. Directory Of Top Specialists For Treating Arab Cash Patients

  3. Arab Women Doctors Network

DMS will complete the entire job with no burden on the client or on the staff. Also, the client's website is used as a reference to perform above services. Moreover, all listed websites are owned and managed by DMS.

Fee :
(one time, special fee). Reg. Fee: $250


  • Made in full and in advance, checks, no credit cards.
  • Check Number  
  • Payment Date   

Contact Information:
First Name   Middle Initials   Family Name
Business Name
Address   City   
Country Info State/Zip Code 
E-mail Address   
Web Site Address

Sending The Order Form .

Please complete the form on line, then print and mail it with your check to:
Doctors' Marketing Service
P.O. Box 748 , Lake Forest, California 92609-0748
E. Mail: affluentpatients@gmail.com

copyright© 2018  Doctors Marketing Service