For current patients only

Refill Request Form

For current patients only

Refill Request Form

Once we receive your request we will contact you directly.

Current medication *
Tirzepatide Pyridoxine (B6) Dosage *
Tirzepatide Sermorelin Dosage *
Semaglutide Dosage *
Lipo-mino Injections Dosage *
Crave-Away Maintenance Dose Dosage *
Crave-Away MAX Dosage *
Dosage Ozempic *
Dosage Wegovy *
Dosage Mounjaro *
Dosage Zepbound *
Do you Experience any Side Effects? *
Would you like to change your dose? *
Current Medication BHRT *
Hormone Cream Dosage *
Compounded Progesterone SR Capsules Dosage *
Thyroid medicine Dosage *
Estradiol patches Dosage *
Micronized Progesterone Capsules Dosage *
Do you Experience any Side Effects? *
Current Medication