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1
What can we help you with?* This field is required.
Suboxone
Tirzepatide
2
Name* This field is required.
First Name
Last Name
3
Email* This field is required.
example@example.com
4
Phone Number* This field is required.This is where we will text your link to join and schedule
Please enter a valid phone number.
5
Do you have a state-issued ID for the state you are in?* This field is required.
YESNO
6
Which state do you live in?* This field is required.
Please Select
Please Select
Arizona
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Idaho
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7
We accept the following Medicaid in Ohio. * This field is required.Please select your insurance or select none.
Please Select
Please Select
Aetna Better Health Ohio Medicaid
Anthem OH (Carelon)
Buckeye Ohio Medicaid
Caresource Ohio Medicaid
Humana Healthy Horizons for OH
Molina Ohio Medicaid
None
8
Terms and Conditions* This field is required.By submitting your information, you authorize Tara Healthcare LLC (RecoveryDelivered.com) to send you text messages related to your care, promotions, and important service updates. Message and data rates may apply. Consent is not a condition of purchase or treatment.
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