Schedule Appointment with Gibbs Pharmacy

Ivermectin Appointment and Screening Form
Are you requesting Ivermectin for COVID-19 treatment or prevention?*

TreatmentPrevention

We are only able to ship medications within Tennessee. If you are out of state, you will have to make your own arrangements for pick up. Please call 615-449-3355 with any questions.*

I acknowledge the shipping laws.

Name*

First NameLast Name
Date of Birth*

MonthDayYear
Address - WE ARE ONLY ABLE TO SHIP MEDICATIONS TO ADDRESSES IN TENNESSEE!! *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email (required)*