Refill Request

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Name* This field is required.
First Name
Last Name
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Follow the standard dosing schedule as directed to avoid adverse reactions and/or intolerable side effects. PLEASE NOTE medications can not be abruptly changed or significantly increased without clinician approval. Connect with us at (404)445-6896 for assistance.
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Select Your Medication.* This field is required.
Semaglutide
Tirzepatide
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Date Of Your Most Recent Injection?* This field is required.
Date
Year
Month
Day
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Current Semaglutide Dosage* This field is required.
Please Select
Please Select
0.25 mg / 10 units
0.5 mg / 20 units
0.75 mg / 30 units
1.0 mg / 40 units
1.5 mg / 60 units
1.7 mg / 68 units
2.0 mg / 80 units
2.4 mg / 96 units
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Requested Semaglutide Dosage* This field is required.
Please Select
Please Select
0.25 mg / 10 units
0.5 mg / 20 units
0.75 mg / 30 units
1.0 mg / 40 units
1.5 mg / 60 units
1.7 mg / 68 units
2.0 mg / 80 units
2.4 mg / 96 units
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Current Tirzepatide Dosage* This field is required.
Please Select
Please Select
2.5 mg / 25 units
5.0 mg / 50 units
7.5 mg / 75 units
10.0 mg / 100 units
12.5 mg / 125 units
15.0 mg / 150 units
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Requested Tirzepatide Dosage* This field is required.
Please Select
Please Select
2.5 mg / 25 units
5.0 mg / 50 units
7.5 mg / 75 units
10.0 mg / 100 units
12.5 mg / 125 units
15.0 mg / 150 units
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Starting Weight* This field is required.
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Current Weight* This field is required.
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Weight loss barriers are usually related to pre-diabetes (elevated A1C), high blood pressure, PCOS, menopause, hormone imbalance, elevated cholesterol levels, insulin resistance, poor dieting and/or slow metabolic function. Experiences are unique, however, stagnancy can indicate the need for nutrition guidance and/or medication modification. Connect with a clinician for re-assessment.
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Rate Your Appetite.* This field is required.
1 (Weak)
2
3 (Strong)
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Are You Getting Full Quicker?* This field is required.
Yes
No
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Are You Experiencing Any Cravings?* This field is required.
Yes
No
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Are Your Clothes Fitting Looser?* This field is required.
Yes
No
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Are You Experiencing Any Complications?* This field is required.
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Are You Experiencing Any Side Effects?* This field is required.Check all that apply.
None
Constipation
Fatigue
Headache
Heartburn
Dehydration
Other
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Remember that these medications are most effective when used in combination with a well balanced diet and regular exercise. Connect with us at (404) 445-6896 or admin@ivuseiv.com for fitness, nutrition and maintenance assistance.
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