Kindly complete the form provided below to express your interest in Compounded Semaglutide as a weight-loss treatment option. Upon review and if deemed suitable, a pharmacist will forward a recommendation for a prescription to your physician. We encourage you to consult with your doctor regarding the potential benefits of Semaglutide for your specific health needs. Informing your physician of the pharmacist's pending recommendation can facilitate a more expedited process. Please note that a prescription issued by your doctor is mandatory, and it is ultimately their professional judgment to decide whether Semaglutide is an appropriate therapeutic option for you.
Your BMI must be at least 27 to be eligible.
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Do you have at least one weight related condition such as high blood pressure(≥130/80), Type 2 diabetes or high cholesterol?
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Yes
No
Do you have a history of medullary thyroid cancer, gallbladder disease, pancreatitis, or Multiple endocrine neoplasia syndrome type 2 (MENS2)?
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Yes
No
Name
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First Name
Last Name
Date of Birth
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-
Month
-
Day
Year
Date
Email
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Who is your primary care provider(PCP)?
*
Which GLP-1 medication are you interested in?
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Semaglutide Oral ($99)
Semaglutide Injection ($250)
Ask the Doctor
To avoid any potential drug interactions between Semaglutide and your other medications, transferring all your prescriptions to our pharmacy allows our system to automatically perform safety checks for you. Would you like to transfer all your medications to Kare Pharmacy?
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Yes
No
Submit
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