Andre Tarin - Patient Refill Request

Patient Refill Request

Scottsdale, AZ
Name*

First NameLast Name
Date of Birth*

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Address*

Street Address

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Testosterone CypionateEstradiol CypionateVitamin B12 InjectionsSemaglutide/PyridoxineSermorelinTirzepatide/PyridoxineHexarelinNAD+ Injection/Infusion (Please specify in box below)Hairloss/Skincare (Please specify in box below)Nandrolone DecanoateProgesterone
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