Send Prescriber Email

Send an email with order forms, dosing, and pricing to a prescriber.
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All Documents

Order forms, roadmaps, calendar, and pricing.

Semaglutide Order Form

Order form for semaglutide.

Semaglutide Higher Dosage Order Form

Order form for higher dosages of semaglutide.

Tirzepatide Order Form

Order form for tirzepatide.

Semaglutide Treatment Roadmap

Roadmap for patients to use for dosing.

Tirzepatide Treatment Roadmap

Roadmap for patients to use for dosing.

Pricing

Pricing for sublingual semaglutide and tirzepatide.

Treatment Calendar

Used to track dosing and side effects.

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Send Prescriber Fax

Send a fax with order forms, dosing, and pricing to a prescriber.
Type of fax:
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Doctor's name to be shown on the cover sheet.
Patient's name to be shown on the cover sheet.
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All Documents

Order forms, roadmaps, calendar, and pricing.

Semaglutide Order Form

Order form for semaglutide.

Semaglutide Higher Dosage Order Form

Order form for higher dosages of semaglutide.

Tirzepatide Order Form

Order form for tirzepatide.

Semaglutide Treatment Roadmap

Roadmap for patients to use for dosing.

Tirzepatide Treatment Roadmap

Roadmap for patients to use for dosing.

Pricing

Pricing for sublingual semaglutide and tirzepatide.

Treatment Calendar

Used to track dosing and side effects.

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Prior Sent Faxes

Get all of the previous faxes, and which documents were sent.

Doctor Name

Patient Name

Time

Documents

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  1. Item 1
  2. Item 2
  3. Item 3
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Semaglutide
0.5 mg/ml
0.75 mg/ml
1 mg/ml
1.25 mg/ml
1.5 mg/ml
2.5 mg/ml
3 mg/ml
1 ml
$50.00
$60.00
$70.00
$74.00
$80.00
$90.00
$95.00
2 ml
$100.00
$120.00
$140.00
$150.00
$160.00
$180.00
$190.00
3 ml
Month 1 $150.00
$154.00
$157.50
$195.00
$215.00
Month 5 $270.00
$285.00
4 ml
$175.00
$192.50
Month 3 $210.00
$270.00
$285.00
Month 6 $300.00
$360.00
5 ml
Month 2 $180.00
$210.00
Month 4 $240.00
$285.00
$330.00
$375.00
$435.00
6 ml
$216.00
$252.00
$288.00
$342.00
$396.00
$450.00
$510.00
7 ml
$252.00
$294.00
$336.00
$399.00
$462.00
$525.00
$585.00
8 ml
$288.00
$336.00
$384.00
$456.00
$528.00
$600.00
$660.00
9 ml
$324.00
$378.00
$432.00
$513.00
$594.00
$675.00
$735.00
10 ml
$360.00
$420.00
$480.00
$570.00
$660.00
$750.00
$810.00
Tirzepatide
5 mg/ml
7.5 mg/ml
10 mg/ml
12.5 mg/ml
15 mg/ml
25 mg/ml
1 ml
$75.00
$85.70
$96.40
$112.50
$115.00
$175.00
2 ml
$150.00
$171.40
$192.80
$225.00
$230.00
$350.00
3 ml
Month 1 $225.00
$257.10
$289.20
$337.50
$345.00
Month 5 $525.00
4 ml
$300.00
$342.80
Month 3 $385.60
$450.00
$460.00
Month 6 $700.00
5 ml
Month 2 $375.00
$428.50
Month 4 $482.00
$562.50
$575.00
$875.00
6 ml
$450.00
$514.20
$578.40
$675.00
$690.00
$1,050.00
7 ml
$525.00
$599.90
$674.80
$787.50
$805.00
$1,225.00
8 ml
$600.00
$685.60
$771.20
$900.00
$920.00
$1,400.00
9 ml
$675.00
$771.20
$867.60
$1,012.50
$1,035.00
$1,575.00
10 ml
$750.00
$857.00
$964.00
$1,125.00
$1,150.00
$1,750.00

Semagltide Treatment Roadmap

Tirzepatide Treatment Roadmap

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