Request Visit

Please enter your information to request a prescription.

Step 1 pErsonal information

Sex

Male

Female

Reason for Visit

Current Medications (if none, type "none")

Known Allergies (if none, type "none")

Past Medical Problems (e.g. Asthma - if none, type "none")

Name of Medication Being Requested

Pharmacy Info

Step 2 - Terms of Use

These Terms of Use must be agreed to by the patient or, when appropriate, the legal guardian.

By checking this box, I certify that, to the best of my knowledge, all medical information submitted is accurate.View terms of use

By checking this box, I agree to follow up with my regular medical provider for ongoing care.

Submit Valid US ID

Upload File

Total Fees (if approved): $49.99

Your credit card will be charged only if your prescription request is approved by your medical provider. This fee does not include the cost of the medication charged by the pharmacy. You will be notified by email once your medical provider reviews your request.

Telehealth Urgent Care

Medical Weight Loss

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Request Visit

Step 1 pErsonal information

Step 2 - Terms of Use

Total Fees (if approved): $49.99