PATIENT INFORMATION

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ORDER DETAILS

Notes

ORDER REFILL OPTIONS: Refill Fee: $200 | If purchasing two vials, the $200 refill fee is waived.

Please select your refill

$600 — Semaglutide 1 mg/mL, 7 mL (Sterile Solution for Injection)

$600 — Semaglutide 5 mg/mL, 2 mL (Sterile Solution for Injection)

$800 — Semaglutide 5 mg/mL, 4 mL (Sterile Solution for Injection)

$650 — Tirzepatide 10 mg/0.5 mL, 2 mL (Sterile Solution for Injection)

$800 — Tirzepatide 10 mg/0.5 mL, 3 mL (Sterile Solution for Injection)

Would you like to add peptides and/or supplements to your order?

Yes

Add-Ons: Peptides

NAD - Supports DNA repair, brain performance, and mental clarity. $175

MicB12 - Supports fat metabolism and liver function a great add in for weight loss clients. $85/$150

SERMORELIN - Fat loss, increased muscle mass, improved sleep and increased libido are among the many benefits. $105/$200

TESAMORELIN - Helps reduce stubborn abdominal fat, improve muscle tone, supports metabolism, promotes better sleep and recovery $210

HEXARELIN - Supports cardiovascular health, fat loss and enhances muscle tone $180

SS-31- Known for improving stamina, focus, and overall cellular health. $450

GLUTATHIONE - A powerful antioxidant that detoxifies the body, brightens the skin, and supports immune and liver health. $100

GHK-CU-BPC 157 -A regenerative peptide blend that promotes healing, collagen production, and tissue repair. $150

L- Carnitine - Helps convert fat into energy, enhances endurance, and supports metabolism. Promotes recovery, focus, and overall energy levels. $100

Add Ons: Supplements & Oral Peptides

NADerall - oral NAD supplement $40

Hexarelin - oral pills $240

Dream Dust - The most bioavailable for of magnesium and l-thiamine for a great nights sleep. Mix 1 scoop with water before bed. $60

Liver Boost- NAC & Glycine, the building blocks for glutathione, one of the body’s most powerful antioxidants. Great for recovery. $40

Truemeric-Curcumin & Hemp Nanoemulsion Softgels. Natural inflammation & pain relief $50

Strength Creatine Powder-A performance-boosting supplement that increases strength, muscle mass, and energy production. Supports improved workout endurance, recovery, and cognitive function. $60

5-Amino-1MQ oral pills $150

GHK-Cu oral pills $150

One-Time Charge Authorization • Initials Required *

I authorize this business to charge the credit card I have provided for the total amount of my selected medication(s) and refill(s). I acknowledge that my payment information may be securely stored for the purpose of processing this order and any future orders I choose to place. I understand I will receive a receipt for this charge once it is processed. I confirm that all information provided is accurate and that I approve this one-time charge as part of my refill request.