Patient Details
Billing note:
Submitting confirms you are OK to be billed using the card you have on file.
If you need to change the card on file, please contact the office before submitting.
Apply for Cherry Financing ↗
0% interest • Pay in 4 options
(Optional) Apply first, then come back and submit your refill.
Commercial / Local Pharmacy
Medication(s)
Local Pharmacy Info
We’ll call this pharmacy to send your commercial refill(s).
Hormones
Select what you need below.
Vitamins / Peptides
These are for REFILLS ONLY. If you have never taken these before, your request will be rejected and you will need a consult with your practitioner and possible lab work.
Select what you need below.
GLP-1 Check-In
Select your vial (Current vs Recommended)
Enter medication, frequency, current pharmacy, and dose per injection to see vial options.
Current pharmacy options
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Recommended best-value option
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Select a vial option to see the dosing math for that vial.
Total mg needed (based on coverage)
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New units per injection
— (U-100)
Estimated weeks per vial
—
Weekly-equivalent mg (for chart)
—
Loaded ✅
Shipping Address
Confirmations
Submitted ✅ If you don’t hear back soon, call the office.
