Please fill out this form completely to determine if you qualify for Ivermectin. There is a $25 initial consultation fee plus the cost of the medication. This fee is annual. If you have paid $25 within the past year, please do not pay again and reach out to the pharmacy for refills. If you have any questions please call the pharmacy at 615-449-3355.

Ivermectin, like penicillin and aspirin, is a drug derived from nature, it was FDA approved for use in parasites in 1987. The drug also has antiviral, anti-inflammatory and anti-cancer activity. It is included in the WHO's list of essential medicines and stockpiled by nations. A Nobel Prize was awarded to the discoverers of Ivermectin in 2015 for their groundbreaking discovery. Over 4 billion doses have been given and the drug has an excellent safety profile after 38 years of use. It is given annually, monthly, or weekly in populations with known parasitic diseases in humans. It has been used off-label in the early treatment of covid illness (SARS-CoV-2) since 2020 because of its unique and highly potent ability to inhibit SARS-CoV-2 viral replication and to suppress inflammation in later stages of disease. 82 studies have been published from 27 countries with 129,808 patients which demonstrate statistically significant (not occurring by chance) improvement in risk of death (mortality), hospitalization, ventilation, and clearance of the virus. The off-label use (FDA approved drug used for other conditions after approval) of medications is widely accepted in medical practice with approximately 20% of all medications prescribed to Americans used in this fashion.Ivermectin should not be used in persons taking certain drugs as listed in the Risk Assessment Tool which the patient will complete. In this Collaborative Pharmacy Agreement, persons under the age 18, pregnant, or breastfeeding women will not be able to obtain ivermectin. Side effects of ivermectin in the treatment of covid are rare, even at high doses, but may include loose stools or nausea, which are also known symptoms of covid illness. Side effects listed for ivermectin in the treatment of parasites are vastly different from those for the treatment of covid due to the inflammatory effect of the death of the parasite when treating parasites. Side effects of veterinarian ivermectin are also vastly different from those of human ivermectin due to other additives, preservatives, and dosing errors which occur with veterinarian forms of ivermectin. How to take ivermectin and what you need to knowThe patient will be given a daily dose of ivermectin based on the patient’s weight by the pharmacist. The cost of ivermectin may not be covered by insurance. There may be an additional charge by the pharmacist for the dispensing of ivermectin. For positive covid diagnosis, you should take the ivermectin daily, with food, for at least five days, as soon as symptoms of illness or covid are noted or your test is positive. Ivermectin works best if started during the first five days of symptoms. You should contact your doctor or a doctor/provider familiar with early covid treatment when you begin ivermectin treatment for further instructions and guidance of treatment. It is recommended that you use zinc 50 mg daily (a vitamin) when taking ivermectin, but your pharmacist may have additional recommendations to maximize your treatment. Stop ivermectin if unusual symptoms appear and report to your doctor. 

*PLEASE NOTE* Payment for the consultation fee is REQUIRED to proceed. Your screening form will not populate to our system unless the payment has been completed. If you have paid the $25 in the past year, do not pay again through this form. Please contact the pharmacy for refills. Payments made by non-Tennessee patients who are unable to arrange for pick-up are non-refundable. Thank you!