Select A Program Below

Medication Refill Request
For questions/concerns please text: (207)400-5826 or call (207)893-8918
NOTE: You are only able to select a program after having a consult with one of our Medical Providers

Your responses will be reviewed by the clinic to ensure you are a current patient and the order is submitted to the pharmacy.

Please click this button to book a follow-up appointment.

(If you have been on the program for at least 2 months, this is required)
Please Answer this question if you have not done so before: What other concerns do you have?*

Anti-Aging: fine lines, wrinkles, texture, etc.Hair removalHormone Health/OptimizationFacial Care: Chemical peels, facials, etc.Body SculptingOther
Your Name (First & Last Name)*
Date of Birth*
Your E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Number of units you are taking*
Total pounds lost*
Current Weight*
Pick up or Ship (if you do not select shipping at the end of the form it will not be shipped)*
Do you need more syringes?*
Additional Info that we should know, or updates to share. If you are on hormone replacement therapy, you can also add the medications that you need refilled here as well.
Please use this link to book a follow-up appointment
You need to have a consult prior to beginning any weight loss program or hormone therapy program.

If you need to schedule, please click the purple "book here" above.
You can still use your HSA, FSA or HRA card

There is also the PayPal pay in 4 option that is similar to Afterpay

You can use your regular Debit/Credit Card even if you do not have a PayPal Account. Once you click "PayPal" you will see the button on the right that says "use debit/credit card"

My Products

SHIPPING(If shipping to YOUR HOUSE)

$32.00 Quantity

NEW Start Weight Loss Program For your very first vial after your consult- S

$425.00 Quantity

Weight Loss Program-Continued monthly fee(up to 70 units)

$350.00 Quantity

Weight Loss Program(80 - 100units)

$400.00 Quantity

Weight Loss Program- TIRZ.Select this if you are taking 25-50 units per week.

$500.00 Quantity

Weight Loss Program- TIRZOrder here if you are at 75 units

$575.00 Quantity

Weight Loss Program- TIRZOrder here if you are taking 100 units or more weekly

$700.00 Quantity

NAD (5-10 weeks depending on dose)By replenishing your body’s levels of NAD+, you can fight the signs of aging, including: Increased energy Decreased inflammation Improved endurance Pain relief Improved memory and concentration Better sleep Improved mood

$250.00 Quantity

Biotin 10ml (10 weeks)

$150.00 Quantity

B12 (10 Weeks) (Methylcobolamin)

$150.00 Quantity

Lipo-Mino (10 Weeks)Blend of: B1, B2, B6, B12, Inositol, Choline & Methionine This blend helps with fat burning, energy and supports a healthy immune system.

$200.00 Quantity

Men's Hormone Replacement ProgramFor patients that are currently enrolled in one of our Hormone Replacement Therapy Programs. Please disregard the shipping charge

$ Free Quantity

Women's Hormone Replacement ProgramFor patients that are currently enrolled in one of our Hormone Replacement Therapy Programs, please disregard the shipping charge. Add what hormones you are currently taking in the NOTES section.

$ Free Quantity

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Total

$0.00

Payment Methods

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Please click one of the PayPal options to complete payment and submit the form.

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Medication Refill Request

For questions/concerns please text: (207)400-5826 or call (207)893-8918