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  • Ivermectin | Mebendazole | Order Form : Prescription is Included

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  • Medicine Counter Pharmacy Building
  • Address: 5506 TN HWY 153, Ste 102, Hixson, TN 37343

    Email: contact@gomedicinecounter.com
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  • HOW TO ORDER? (Average time to complete this form is 15 min)

  • STEP 1: FILL OUT ALL THE INFO

  • STEP 2: SELECT THE CORRECT DOSAGE BASED ON CONDITION

  • STEP 3: ENTER THE PAYMENT INFO, SIGN AND SUBMIT

  • How would you like to place this order?
  • To subscribe, please click the banner below to open the subscription order form. You will save 30% on every renewal and may cancel anytime. This option is only available for eligible Cancer Care, Parasite Cleanse, or COVID Prevention requests for Ivermectin or Mebendazole.
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  • Format: (000) 000-0000.
  • Please select the medication(s) you wish to purchase. (Select more than one if applicable)*
  • Please select the reason for your request. Some requests may involve off-label use. For those conditions, the licensed provider will review and approve the order after reviewing the medical information provided on this intake form to allow for safe and effective use these medications. Your payment will be processed once your order is approved.
  • Select the Reason for Requesting Ivermectin*
  • Select the Reason for Requesting Provider Review (Mebendazole)*
  • Select the Reason for Requesting Ivermectin*
  • Select the Reason for Requesting Mebendazole*
  • Please select your current stage of Cancer*
  • *Ivermectin weight based dosage selection (Please read the details below)*

    Please find the correct dosage based on your body weight from the table below and purchase ivermectin capsules accordingly. You may choose to select one or more recommended dose or lower dosage than recommended, however, the pharmacist/provider will NOT approve the order if you select the dosage that is HIGHER than your body weight range from the table below.
  • Example # 1 (Active Infection): Covid Positive Patient who weighs 185LB: Take 1 capsule of 45mg with food once a day for 5 to 10 days until recovered.

  • Example # 2 (Covid Prevention): Patient who weighs 220LB and would like to take it for Covid Prevention: Take 1 capsule of 30mg Twice a week while the disease risk is high.

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  • Are you currently undergoing any of the following?*
  • Are you COVID-19 Positive?*
  • Are you requesting Compounded Oral Ivermectin for supportive care in Current/Active or Future Covid-19 infection? (select "Yes" for treatment, and select "No" for requesting for prevention)*
  • Are you requesting Compounded Oral Ivermectin for the Treatment of Long Covid (Long Haulers/ Post Covid condition)? (select "Yes" for Long Covid-19 treatment, and select "No" for requesting for prevention)*
  • Are you requesting Compounded Oral Ivermectin for the prevention of Covid-19 infection?*
  • Are you requesting Compounded Oral Ivermectin capsules for adjunctive treatment of Cancer?*
  • Do you have a history of lice, skin parasites, or itching related to parasite exposure?*
  • What are your current symptoms of parasite infection? Mark all that apply.*
  • Applicable only if taking Warfarin or other anticoagulants: I understand that Ivermectin may increase INR levels and raise bleeding risk. I agree to monitor INR and consult my provider if needed.*
  • Have you previously taken Mebendazole?*
  • Do you currently have severe liver disease or have a history of it?*
  • Have you personally seen evidence of parasites on your skin or in your stool?*
  • Methylene Blue Capsules

  • Neuropathic Pain Cream

  • Do you have numbness or reduced sensation in the planned treatment area(s)?*
  • Are you currently using other pain treatments (topical or oral), including NSAIDs/acetaminophen, anticonvulsants, antidepressants, opioids, muscle relaxants, or other anesthetic creams/patches?*
  • Arthritis Pain Cream

  • Are you currently using other pain treatments (topical or oral), including NSAIDs, acetaminophen, opioids, muscle relaxants, nerve agents, or other anesthetic creams/patches?*
  • Are you taking anticoagulants/antiplatelets (e.g., warfarin, DOACs, clopidogrel), or do you have a history of stomach ulcers/bleeding, severe kidney disease, severe liver disease, uncontrolled blood pressure, asthma triggered by NSAIDs/aspirin, heart rhythm problems,arrhythmia,A.Fibrilation, seizures, or heart failure?*
  • Do you have numbness/tingling or reduced sensation in the planned treatment area(s)?*
  • Acne / Acne Scars Cream

  • Have you previously used topical retinoids (tretinoin/retinol) or topical antibiotics for acne?*
  • Are you currently using other active skincare (e.g., benzoyl peroxide, AHAs/BHAs like glycolic/salicylic acid, azelaic acid, steroids) or had recent peels/laser/microneedling/waxing?*
  • Have you taken oral isotretinoin (Accutane) in the past 6 months?*
  • Have you ever had severe diarrhea or colitis associated with antibiotics (e.g., C. difficile)?*
  • Do you have any medical conditions affecting skin healing or sensitivity (e.g., severe eczema/dermatitis, psoriasis, active rosacea flare, photosensitivity disorders, keloid tendency)?*
  • Ultimate Fairness Cream

  • Have you previously used Hydroquinone, Tretinoin, or topical corticosteroids?*
  • Are you currently using other active skincare (e.g., benzoyl peroxide, AHAs/BHAs/glycolic/salicylic acid, other vitamin C serums, retinoids, steroids) or had recent peels/laser/microneedling/waxing?*
  • Do you have any medical conditions affecting skin healing or pigment (e.g., severe eczema/dermatitis, psoriasis, active rosacea flare, history of vitiligo or unusual loss of skin color, keloid tendency)?*
  • Umtimate Anti-Aging Cream

  • Are you currently using other active skincare (e.g., benzoyl peroxide, AHAs/BHAs/glycolic/salicylic acid, vitamin C serums, steroids), or had recent peels/laser/microneedling/waxing?*
  • Do you have any medical conditions affecting skin healing or sensitivity (e.g., severe eczema/dermatitis, psoriasis, active rosacea flare, keloid tendency)?*
  • Male: Hair Loss Solution

  • Are you using any other hair/scalp treatments now (e.g., topical/oral minoxidil, finasteride/dutasteride, spironolactone, ketoconazole shampoo, steroids, retinoids, PRP/microneedling)?*
  • Are you using any other hair/scalp treatments now (e.g., topical/oral minoxidil, finasteride/dutasteride, spironolactone, ketoconazole shampoo, steroids, retinoids, PRP/microneedling)?*
  • Have you ever been under care for prostate conditions (e.g., BPH, elevated PSA, prostate cancer) or had unexplained urinary symptoms (weak stream, urgency, night urination)?*
  • Female: Hair Loss Solution

  • Are you using any other hair/scalp treatments now (e.g., topical/oral minoxidil, finasteride/dutasteride, spironolactone, ketoconazole shampoo, steroids, retinoids, PRP/microneedling)?*
  • Do you have any current or past medical conditions (especially heart disease, chest pain, arrhythmia, low blood pressure, edema/swelling, kidney or severe liver disease, thyroid or iron issues, PCOS, major recent illness/surgery)?*
  • Tadalafil (Cialis)

  • Have you ever taken Tadalafil or other ED medicines before?*
  • Do you use nitrates (nitroglycerin, isosorbide), recreational nitrites (“poppers”), or riociguat? (These must not be combined with Tadalafil)*
  • Are you taking alpha-blockers (e.g., tamsulosin/doxazosin) or other blood-pressure–lowering meds?*
  • Are you taking medicines that may interact (e.g., ketoconazole/itraconazole, ritonavir/cobicistat, clarithromycin/erythromycin, rifampin, carbamazepine/phenytoin, St. John’s wort, or grapefruit products)?*
  • Do you have serious kidney or liver disease?*
  • Do you have retinal disorders (e.g., retinitis pigmentosa) or a history of sudden vision loss/NAION?*
  • History of hearing loss, ringing, or sudden decrease in hearing?*
  • Any penile anatomy issues (e.g., Peyronie’s) or conditions that predispose to priapism (sickle cell disease, leukemia, myeloma)?*
  • Any bleeding disorder or use of anticoagulants/antiplatelets?*
  • Sildenafil (Viagra)

  • Have you ever taken Sildenafil or other ED medicines before?*
  • Do you use nitrates (nitroglycerin, isosorbide), recreational nitrites (“poppers”), or riociguat? (These must not be combined with Sildenafil.)*
  • Are you taking alpha-blockers (e.g., tamsulosin/doxazosin) or other blood-pressure–lowering meds?*
  • Are you taking any medicines that may interact (e.g., ketoconazole/itraconazole, ritonavir/cobicistat, clarithromycin/erythromycin, rifampin, carbamazepine/phenytoin, St. John’s wort, grapefruit products)?*
  • Do you have serious kidney or liver disease?*
  • Do you have retinal disorders (e.g., retinitis pigmentosa) or a history of sudden vision loss/NAION?*
  • History of hearing loss, ringing, or sudden decrease in hearing?*
  • Any penile anatomy issues (e.g., Peyronie’s) or conditions that predispose to priapism (sickle cell disease, leukemia, myeloma)?*
  • Any bleeding disorder or use of anticoagulants/antiplatelets?*
  • *Ivermectin weight based dosage selection (Please read the details below)*

    Please find the correct dosage based on your body weight from the table below and purchase ivermectin capsules accordingly. You may choose to select one or more recommended dose or lower dosage than recommended, however, the pharmacist will NOT approve the order if you select the dosage that is HIGHER than your body weight range from the table below.
  • Example # 1 (Active Infection): Covid Positive Patient who weighs 185LB: Take 1 capsule of 45mg with food once a day for 5 to 10 days until recovered.

  • Example # 2 (Covid Prevention): Patient who weighs 220LB and would like to take it for Covid Prevention: Take 1 capsule of 30mg Twice a week while the disease risk is high.

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  • Note: Ivermectin is not FDA-approved for COVID-19 treatment or Prevention. The licensed prescriber may prescribe this as an off-label use based on limited clinical data on a case-by-case basis.

  • (Aggressive Cancer Treatment, Stage 2, 3 or 4, Metastasized): Patient who weighs 155LB and aggressively treating cancer: Take 1 capsule of 40mg once a day with food for 7-14 days, if tolerated, may increase to 40mg capsule twice a day with food.

  • (Non Aggressive Cancer Treatment, Stage 1, Non-Metastasized): Patient who weighs 155LB and aggressively treating cancer: Take 1 capsule of 40mg once a day with food.

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  • Provider Review Required: Do not start, change, repeat, or continue any medication unless directed by the licensed provider. The provider may approve a different dose, lower dose, shorter duration, alternative therapy, or may deny the request if it is not clinically appropriate. You will not be charged in case of denial.

  • Note: Ivermectin is not FDA-approved for Cancer Treatment or Prevention. The licensed prescriber may prescribe this as an off-label use based on limited clinical data on a case-by-case basis.

  • Note: Mebendazole is not FDA-approved for Cancer Treatment or Prevention. The licensed prescriber may prescribe this as an off-label use based on limited clinical data on a case-by-case basis.

  • (Parasite Treatment): Patient who weighs 155LB: Take 1 capsule of 25mg once a day on an empty stomach for 5 days.

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  • Purchase Products Below (Ivermectin SHELF LIFE - Although formulation beyond use date (BUD) is normally 6 months by default, However, Ivermectin API powder used expires on 03/2028)*

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        Chlo Hist Cough Syrup (120ml) (best cough syrup)

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        Shipping / Pickup Option
        Select Correct Shipping or Curbside Pick-up option Below . Allow up-to 24 hours to get your order ready. If it is urgent, please call the pharmacy at 423-680-7373 to request to have your order ready faster during business hours
        Select Correct Shipping or Curbside Pick-up option Below

        Allow up-to 24 hours to get your order ready. If it is urgent, please call the pharmacy at 423-680-7373 to request to have your order ready faster during business hours

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      • Important Notice

        After submission, your request will be reviewed by a licensed provider. In some cases, the provider may require a telehealth consultation (phone or video) to complete the evaluation. You may be contacted using your registered email or phone number. A licensed provider will review your health history, medications, allergies, weight, and request before making a final decision. If your request is denied by the provider, you will not be charged for the medication. Once approved, your order may be processed and fulfilled from one of our licensed pharmacy facilities based on availability, location, and operational needs.
      • Click Submit to Complete the order.

        Although Rarely, If the transaction declines on the next window, there could be a few reasons why it declined. 1. Check for text, phone, app, or email alert from the credit card company to approve this transaction. If you don't receive any alert, please call the credit card company to verify the transaction and try again. 2. Make sure you have entered the correct Billing Address for the payment card. 3. Make sure you have entered the correct Security code (CVV) payment card. Visa, Mastercard, Discover prints 3 digit the security code (CVV) on the back of the card. American Express prints 4 digit CVV code on the front side of top right corner. 4. If you don't see the Shipping Option page next after clicking submit, please clear cookies and caches of your browser by going in TOOLS tab of your browser, then clear browsing data. 5. Should you still need further assistance, Please call the pharmacy during business hours at 423-680-7373. Thank you.
      • Medicine Counter Pharmacy Building
      • Should be Empty: