medication request form
Most of our patients report that they begin feeling dramatically better in just 14 days! Don’t wait to get started, fill out the form below and one of our clinical pharmacists will review your information and contact you.
We will then contact your doctor on your behalf with our recommendations for a prescription for the best custom compounded medication. We will also check to see if it’s covered by your insurance plan.
Once we review your final approval, we will custom-compound your medication. You can either pick it up or we would be happy to mail it directly to you. Just let us know which you prefer.