Enclomiphene - 25 mg per capsule

Enclomiphene - 25 mg per capsule

Number of capsules per bottle: 24 - three month supply (2 capsules by mouth per week) Expiration 11/10/2026
Enclomiphene Questionaire
Name*

First NameLast Name
Date of Birth *

MonthDayYear
Date
I am pregnant or am planning on getting pregnant: (NOTE- If the answer is yes, please stop and do not purchase enclomiphene). *
I understand enclomiphene may cause changes in vision, bloating, changes in sleep, fatigue, restlessness, changes in mood, and breast discomfort. *
Please list all medical diagnosis and/or medical problems. If you have never been diagnosed with any condition, write "NA."*
Please list all medications or substances you are using/taking. This includes over the counter medications. If you do not take anything, write "NA."*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please list all medication allergies. If you do not have any, write "NA.*
Is your plasma testosterone level greater than 1200? *
Email*
example@example.com
Please list any and all allergies to medications*
You agree to take Enclomiphene 25 mg capsules no more than three times per week. If you are feeling faint, drowsy, or have any side effects from Enclomiphene, stop usage and contact your primary care physician. *

Powered by Jotform SignClear

My Products*

Enclomiphene 25 mg capsules / 24 capsules per bottle - 3 month supply at two capsules per week (shipping included)

$180.00 Quantity

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

I understand Dr. David Mahjoubi recommends taking one 25 mg Capsule of Enclomiphene every 3-4 days, and recommends not taking more than 75 mg per week. *

Powered by Jotform SignClear
The IV Healing Spa requires patients who have been on Enclomiphene to submit lab values for Total Testosterone, Free Testosterone, and Estrogen once a year. If you have been receiving Enclomiphene from us for one year or more, please submit these lab values to support@ketaminehealing.com. Thank you. This is required every year to continue getting enclomiphene from us. *
How did you hear about us? *
Should be Empty:

Enclomiphene Questionaire