Andre Tarin - Patient Refill Request

Patient Refill Request

Jefferson City and Knoxville, TN
Name*

First NameLast Name
Date of Birth*

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Email*
example@example.com
Phone Number*
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Address*

Street Address

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CityState / Province

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Type of Refill(s) Needed:*

Testosterone CypionateEstradiol CypionateVitamin B12 InjectionsSemaglutide/PyridoxineSermorelinTirzepatide/PyridoxineHexarelinIV Hydration with Lactated RingersIV Myer's Cocktail in Lactated RingersNandrolone DecanoateProgesterone
Delivery Location*
Delivery Method*
Additional Comments
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