First Name
Last Name
Date of Birth
Email
Phone Number
Address
Street
City
State
ZIP
Type of Refill(s) Needed:
Testosterone Cypionate
Estradiol Cypionate
Vitamin B12 Injections
Semaglutide/Levocarnitine
Sermorelin
Tirzepatide/Levocarnitine
Hexarelin
IV Hydration with Lactated Ringers
IV Myer's Cocktail in Lactated Ringers
Nandrolone Decanoate
Progesterone
Delivery Method
Ship to Address on File (additional shipping fees apply)
Weekly In-Office Injection
EAST SIDE pick up: 6565 E Carondelet Dr Ste 301
NORTHWEST pick up: 2055 W Hospital Dr Ste 145
Additional Comments: