• Servicing : Arizona, Florida, Minnesota, Maryland, Nevada, New York, Oregon and Washington.
Facebook Instagram Tiktok Envelope
BOOK APPOINTMENT

RX REFILL

Use this form when you have taken your 3rd injection.  Please schedule a follow up appointment to discuss progress and to make adjustments.

"*" indicates required fields

MM slash DD slash YYYY
Location*
Current RX*
Do you want to stay at current dose*
Do you want to charge card on file or be invoiced*