Step 1 of 2 50% Order Type* New Order Order Refill Provider* Cassie Gifford, RN, BSN, FNP David Plaisance, FNP-C Elizabeth Snedeker, PA-C, MSPAS Henriette Eva Hvingelby, PhD, NP-C Joleen M. Jimenez, MSN, FNP-C Miklos Major, Sc.D., DNP, NP-BC Nancy Long, FNP-C Tanya Zucco, PA-C Viking Location* VIKING - Corporate VIKING - Chesterfield VIKING - TriMax Health and Fitness Choice Date* MM slash DD slash YYYY Patient Name* First Middle Last Date of Birth* MM slash DD slash YYYY Patient's Phone Number*Driver's License #* Patient's Email* HiddenBilling same as shipping? Yes No Billing address* Street Address Address Line 2 City ALAKASAZARCACOCTDEDCFLGAGUHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDMPOHPuerto RicoOKORPAPRRISCSDTNTXUTVIVTVAWAWVAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanWIWY State ZIP Code Shipping Address* Same as Billing Street Address Address Line 2 City ALAKASAZARCACOCTDEDCFLGAGUHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDMPOHPuerto RicoOKORPAPRRISCSDTNTXUTVIVTVAWAWVAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanWIWY State ZIP Code HSA Card?YesNoHSA Card Number Month/Year 3 digit Security Code Cardholder's name Hormone Replacement Therapy Packages HRT for Male Female Male HRT PackageChoose Desired PackagePackage - Choose desired package typeMake a selection to choose a quantitySelect correct optionTestosterone Injectable ProtocolTestosterone Needle Free ProtocolPackage Quantity*Please enter a number from 1 to 1.Anastrozole*Select correct optionSelect correct optionNO ANASTROZOLE#5 Anastrozole 1 mg - Take 1/4 tablet (0.25 mg) by mouth 2x weekly#10 Anastrozole 1 mg - Take 1/4 (0.25 mg) - 1/2 tablet (0.5 mg) by mouth 2x weekly#20 Anastrozole 1 mg - Take 1/2 tablet (0.5 mg) - 1 tablet (1mg) by mouth 2x weeklyChoice#20 Anastrozole 1 mg - Take 1 tablet (1 mg) by mouth 2x weeklyExemestaneSelect Correct OptionSelect Correct Option#5 Exemestane 25 mg - Take 1/2 tablet (12.5 mg) by mouth 2x weekly#10 Exemestane 25 mg - Take 1 tablet (25 mg) by mouth 2x weeklyTestosterone CreamSelect correct optionChoose correct optionTestosterone Cream 100 MG/GM (10%) - 30 GM - Apply 1 click in the AM and 1 click in the PMTestosterone Cream 200 MG/GM (20%) - 30 GM - Apply 1 click in the AM and 1 click in the PMTestosterone Cream 200 MG/GM (20%) - 60 GM - Apply 2 clicks in the AM and 2 clicks in the PMTestosterone Cream 200 MG/GM (20%) - 90 GM - Apply 3 clicks in the AM and 3 clicks in the PMTestosterone Cream 200 MG/GM (20%) - 120 GM - Apply 4 clicks in the AM and 4 clicks in the PMTestosterone TrocheSelect correct optionChoose correct optionTestosterone Troche 50 mg - #60- Dissolve 1/2 (25 mg) troche under tongue every morning and eveningTest/Cyp 200 MG/mLSelect Correct OptionSelect Correct OptionTest/Cyp 200 mg/ml - 5 ml - Inject 0.2 ml (40 mg) by intramuscular route 2x weeklyTest/Cyp 200 mg/ml - 5 ml - Inject 0.25 ml (50 mg) by intramuscular route 2x weeklyTest/Cyp 200 mg/ml - 10 ml - Inject 0.3 ml (60 mg) by intramuscular route 2x weeklyTest/Cyp 200 mg/ml - 10 ml - Inject 0.35 ml (70 mg) by intramuscular route 2x weeklyTest/Cyp 200 mg/ml - 10 ml - Inject 0.375 mL (75 mg) by intramuscular route 2x weeklyTest/Cyp 200 mg/ml - 10 ml - Inject 0.4 mL (80 mg) by intramuscular route 2x weeklyTest/Cyp 200 mg/ml - 10 ml - Inject 0.425 mL (85 mg) by intramuscular route 2x weeklyTest/Cyp 200 mg/ml - 10 ml - Inject 0.45 ml (90 mg) by intramuscular route 2x weeklyTest/Cyp 200 mg/ml - 10 ml - Inject 0.5 ml (100 mg) by intramuscular route 2x weeklyTest/Cyp 200 mg/ml - 15 ml - Inject 0.6 ml (120 mg) by intramuscular route 2x weeklyTest/Cyp 200 mg/ml - 15 ml - Inject 0.625 ml (125 mg) by intramuscular route 2x weeklyTest/Cyp 200 mg/ml - 15 ml - Inject 0.7 ml (140 mg) by intramuscular route 2x weeklyTest/Cyp 200 mg/ml - 15 ml - Inject 0.75 ml (150 mg) by intramuscular route 2x weeklyTest/Cyp/Prop 180/20 mg/mlSelect correct optionSelect Correct OptionTest/Cyp/Prop 180/20 mg/ml - 10 ml - Inject 0.5 (100 mg) ml by intramuscular route 2x weeklyTest/Enanthate 200mg/mlSelect correct optionSelect Correct OptionTest/Enanthate 200 mg/ml - 10 ml - Inject 0.5 ml (100 mg) by intramuscular route 2x weeklySyringe Options*Select Correct OptionSelect Correct OptionNo Syringes#20 IM syringes#20 Insulin syringesFemale HRT PackageChoose Desired PackageFemale Package - Choose desired package typeMake a selection to choose a quantitySelect correct optionTestosterone Injectable ProtocolTestosterone Needle Free ProtocolPackage Quantity*Please enter a number from 1 to 1.Testosterone Cream*Select correct optionSelect Correct OptionTestosterone Cream 10 MG/GM (1%) - 15 GM - Apply 1 click daily as directedTestosterone Cream 10 MG/GM (1%) - 30 GM - Apply 1 click in the AM and 1 click in the PMTestosterone Cream 10 MG/GM (1%) - 60 GM - Apply 2 clicks in the AM and 2 clicks in the PMTest/Cyp 200 MG/mL*Select correct optionSelect Correct OptionTest/Cyp 200 MG/mL - 1 mL - Inject 0.05 mL (5 units) 1x every 10 daysTest/Cyp 200 MG/mL - 1 mL - Inject 0.05 mL (5 units) 1x every 7 daysTest/Cyp 200 MG/mL - 1 mL - Inject 0.1 mL 1x every 14 daysTest/Cyp 200 MG/mL - 1 mL - Inject 0.1 mL 1x every 10 daysTest/Cyp 200 MG/mL - 1 mL - Inject 0.1 mL 1x every 7 daysTest/Cyp 200 MG/mL - 1 mL - Inject 0.2 mL 1x every 10 daysTest/Cyp 200 MG/mL - 1 mL - Inject 0.2 mL 1x every 7 daysTest/Cyp 200 MG/mL - 1 mL - Inject 0.3 mL 1x every 5 daysSyringe Options*Select Correct OptionSelect correct option#10 insulin syringesHidden MEDICATIONSAnastrozoleSelect correct optionAnastrozole 1 mg - Take 1/2 tablet (0.5 mg) by mouth 2x weeklyAnastrozole 1 mg - Take 1/2 tablet (0.5 mg) by mouth every other dayAnastrozole 1 mg - Take 1 tablet (1 mg) by mouth 3x weeklyAnastrozole 1 mg - Take 1 tablet (1 mg) by mouth 2x weeklyQuantityAOD 9604 TrocheSelect correct optionAOD 9604 - 600 MCG - Dissolve 1 troche under tongue every morningQuantityBio-CreamSelect correct optionBio-Cream BPC 157- 5mg / GHK-Cu 5mg/ml - 15ml Pump - Apply 2 pumps to clean face daily in the morningQuantityBi-Estrogen CreamSelect correct optionBi-Estrogen Cream - 0.25 MG/G - 30g Topi-Click - Apply 1 click (0.0625 mg) daily as directedBi-Estrogen Cream - 0.25 MG/G - 30g Topi-Click - Apply 2 clicks (0.125 mg) daily as directedBi-Estrogen Cream - 1 MG/G - 30g Topi-Click - Apply 1 click (0.25 mg) daily as directedBi-Estrogen Cream - 1 MG/G - 30g Topi-Click - Apply 2 clicks (0.50 mg) daily as directedBi-Estrogen Cream - 5 MG/G - 30g Topi-Click - Apply 2 clicks daily (2.5mg) as directedBi-Estrogen Cream - 5 MG/G - 30g Topi-Click - Apply 2 clicks daily (2.5mg) as directedQuantityBPC157 INJECTABLE - HALLANDALE ONLYSelect correct optionBPC157 - 10 MG vial - Reconstitute w/ 4ml BAC water - Inject 20 units by subcutaneous route 2x weeklyBPC157 - 10 MG vial - Reconstitute w/ 4ml BAC water - Inject 20 units by subcutaneous route dailyBPC157 - 10 MG vial - Reconstitute w/ 4ml BAC water - Inject 30 units by subcutaneous route dailyBPC157 - 15 MG vial - Reconstitute w/ 6ml BAC water - Inject 20 units by subcutaneous route dailyQuantityBPC157 Oral Capsule - HALLANDALE ONLYSelect correct optionBPC157 - 500 MCG - Take 1 capsule every day as neededQuantityCabergolineSelect correct optionCabergoline 0.5 MG (#8 tablets) - Take 1/2 tablet (0.25 mg) by mouth 2x weeklyQuantity (1 bottle = 8 Tablets)Clomiphene (Clomid)Select correct optionClomiphene -25 mg capsule - Take 1 capsule dailyClomiphene -50 mg capsule - Take 1 capsule dailyQuantityDHEA SR CAPSULESSelect correct optionDHEA - 10 MG SR Capsule - Take 1 capsule daily in the morningDHEA - 15 MG SR Capsule - Take 1 capsule daily in the morningDHEA - 25 MG SR Capsule - Take 1 capsule daily in the morningDHEA - 50 MG SR Capsule - Take 1 capsule daily in the morning ChoiceDHEA - 100 MG SR Capsule - Take 1 capsule daily in the morningQuantityECASelect correct optionECA - 20/200/30 mg(#90 capsules) - Take 1 tablet by mouth 1x dailyQuantity (1 bottle = 90 capsules)ExemestaneSelect Correct OptionExemestane 25 MG - Take 1/2 tablet (12.5 mg) by mouth 2x weeklyExemestane 25 MG - Take 1 tablet (25 mg) by mouth 2x weeklyQuantityFinasterideSelect correct optionFinasteride 1 MG - Take 1 tablet (1 mg) by mouth 1x dailyFinasteride 5 MG - Take 1 tablet (5 mg) by mouth 1x dailyQuantityGAC (amino) L-Glutamine 25mg / L-Arginine 100mg / L-Carnitine 200mg - 30ml vialSelect correct optionGAC (amino) L-Glutamine 25mg / L-Arginine 100mg / L-Carnitine 200mg - 30ml vial - Inject 1 mL pre/post workout by intramuscular route AS NEEDEDQuantityGlutathioneSelect correct optionGlutathione 200mg/ml - 10 mL - Inject 0.5 mL by intramuscular route 2x weekly OR AS NEEDEDGlutathione 200mg/ml - 10 mL - Inject 0.5 mL by intramuscular route 3x weekly OR AS NEEDEDGlutathione 200mg/ml - 10 mL - Inject 1 mL by intramuscular route 3x weekly OR AS NEEDEDGlutathione 200mg/ml - 10 mL - Inject 1 mL by intramuscular route daily OR AS NEEDEDGlutathione 200mg/ml - 30 mL - Inject 0.5 mL by intramuscular route 2x weekly OR AS NEEDEDGlutathione 200mg/ml - 30 mL - Inject 0.5 mL by intramuscular route 3x weekly OR AS NEEDEDGlutathione 200mg/ml - 30 mL - Inject 1 mL by intramuscular route 3x weekly OR AS NEEDEDGlutathione 200mg/ml - 30 mL - Inject 1 mL by intramuscular route daily OR AS NEEDEDQuantityGonadorelin - 5ml Recon - Vial (Std 5 weeks)Select Correct OptionGonadorelin 200mcg/ml - 5ml vial - Inject 50 units 2x per week - Includes 1 bag insulin syringesQuantityGonadorelin 2mg Lyophilized (Std 10 weeks)Select Correct OptionGonadorelin 2mg Vial - Inject 50 units by subcutaneous route 2x weekly. Reconstitute with 10ml bac water; Includes 2 bags insulin syringesGonadorelin 2mg Vial - Inject 50 units by subcutaneous route 3x weekly. Reconstitute with 10ml bac water - Includes 2 bags of insulin syringesQuantityHCG - RITE AWAY PHARMACYSelect Correct OptionHCG 5000iu vial - Inject 25 units 2x per week. Reconstitute with 5ml of bac water; Includes 2 bags insulin syringesHCG 5,000iu vial - Inject 25 units 3x per week. Reconstitute with 5ml of bac water'; Includes 2 bags insulin syringesHCG 5,000iu vial - Inject 50 units 2x per week. Reconstitute with 5ml of bac water; Includes 2 bags insulin syringesQuantityKisspeptin-10 1mg (1 vial is 5 weeks at standard dosage)Select correct optionKisspeptin-10 1mg Vial - Inject 25 units by subcutaneous route 2x weekly. Reconstitute with 2.5ml of bacteriostatic water; Includes 1 bag insulin syringesKisspeptin-10 1mg Vial - Inject 50 units by subcutaneous route 2x weekly. Reconstitute with 2.5ml of bacteriostatic water; Includes 1 bag insulin syringesQuantityL CarnitineSelect correct optionL Carnitine 500mg/ml - 30 ml vial - Inject 0.5 ml intramuscularly 2x per weekL Carnitine 500mg/ml - 30 ml vial - Inject 1 ml intramuscularly 2x per weekQuantityLetrozoleSelect correct optionLetrozole 2.5 MG - Take 1 tablet (2.5 mg) by mouth 2x weekly AS NEEDEDQuantityLipo CSelect correct optionLipo C - 10 mL - Inject 1 mL by intramuscular route 1x weeklyLipo C - 10 mL - Inject 1 mL by intramuscular route 2x weeklyLipo C - 10 mL - Inject 1 mL by intramuscular route dailyQuantityMagic PillSelect correct optionThe Magic Pill (#60 capsules) - Take 1-2 capsules by mouth 2x dailyQuantity (1 bottle = 60 Capsules)Melatonin 5mg (+B6 10mg) 90ct BottleSelect correct optionMelatonin 5mg (+B6 10mg)(#90 tablets) - Take 1 capsules by mouth 30 minutes to 1 hour before bed AS NEEDEDQuantity (1 bottle = 90 Capsules)Methylcobalamin B12Select correct optionB12 - 10 mL - Inject 1 mL by intramuscular route 2x weeklyQuantityMIC B12 / BioBoostSelect correct optionMIC B12/BioBoost - 30 mL - Inject 1 mL by intramuscular route 2x weeklyQuantityMetforminSelect correct optionMetformin 500 MG - Take 1 tablet (500 mg) by mouth 2x daily AS NEEDEDQuantityHiddenModafinil (Provigil)Select correct optionModafinil-200 MG - Take 1/2 -1 tablet (100 mg - 200 mg) by mouth 1x daily AS NEEDEDModafinil-200 MG - Take 1 tablet (200 mg) by mouth 1x daily AS NEEDEDHiddenQuantityPlease enter a number from 1 to 30.Nandrolone (Deca)Select correct optionNandrolone (Deca) 200 MG/mL - 10 mL - Inject 0.2 mL (20 units)(40mg) by intramuscular route 2x weeklyNandrolone (Deca) 200 MG/mL - 10 mL - Inject 0.3 mL (30 units)(60mg) by intramuscular route 2x weeklyNandrolone (Deca) 200 MG/mL - 10 mL - Inject 0.4 mL (40 units)(80mg) by intramuscular route 2x weeklyNandrolone (Deca) 200 MG/mL - 10 mL - Inject 0.5 mL (50 units)(100mg) by intramuscular route 2x weeklyQuantityPregnenolone CapsulesSelect correct optionPregnenolone 100 MG Capsules - Take 1 capsule daily in the morningQuantityProgesterone Capsules (ALL)Select correct optionProgesterone 50 MG - Take 1 capsule (50 mg) by mouth every nightProgesterone 100 MG - Take 1 capsule (100 mg) by mouth every nightProgesterone 200 MG - Take 1 capsule (200 mg) by mouth every nightProgesterone 300 MG - Take 1 capsule (300 mg) by mouth every nightQuantityProgesterone Capsules (200mg only)Select correct optionProgesterone 200 MG - Take 1 capsule (200 mg) by mouth every nightProgesterone 50 MG - Take 1 capsule (50 mg) by mouth every nightQuantityProgesterone TrochesSelect correct optionProgesterone 100 MG TROCHE - SEE DOSAGE INSTRUCTIONS BELOWProgesterone 200 MG TROCHE - SEE DOSAGE INSTRUCTIONS BELOWQuantityPhentermineSelect correct optionPhentermine 37.5 MG - Take 1 tablet (37.5 mg) by mouth 1x dailyQuantityPlease enter a number from 1 to 30.PT 141 (Bremelanotide)Select correct optionBremelanotide (PT-141) 10mg - 2ml vial -0.1 cc by subcutaneous route every 3 days as neededBremelanotide (PT-141) 10mg - 2ml vial -0.2 cc by subcutaneous route every 3 days as neededBremelanotide (PT-141) 10mg - 2ml vial -0.05 cc by subcutaneous route every 3 days as neededBremelanotide (PT-141) 10MG/ML - 5ml nasal sprayExpedited Shipping Charge $75 for states: AL AR CA HI IN MI MN NE NJ QuantityScream Cream (Sildenafil / L-Arginine / Aminophylline / Testosterone Cream)Select correct optionScream Cream - Sildenafil / L-Arginine / Aminophylline / Testosterone Cream - 15g - Apply 1-2 clicks to genital area as needed 30 minutes prior to sexual activityQuantitySecretagogue - CJC 1295 / Sermorelin / Ipamorelin TrocheSelect Correct OptionCJC 1295 / Sermorelin / Ipamorelin - 300 mcg / 300 mcg / 300 mcg - Dissolve 1 troche under tongue nightlyQuantitySecretagogue - Duo-Blend Vial & TrocheSelect correct optionDuo Blend -Ipamorelin/CJC-1295 9mg/5mg vial -Inject 0.1ml (10 units) every evening on empty stomach. 6ml bacteriostatic waterDuo Blend -Ipamorelin/CJC-1295 9mg/5mg vial -Inject 0.2ml (20 units) every evening on empty stomach. 6 ml bacteriostatic waterDuo Blend -Ipamorelin/CJC-1295 9mg/5mg vial -Inject 0.2ml (20 units) every evening on empty stomach. 9ml bacteriostatic waterDuo Blend -Ipamorelin/CJC-1295 9mg/5mg vial -Inject 0.4ml (40 units) daily. 9ml bacteriostatic waterCJC 1295 / Ipamorelin - 300 mcg / 300 mcg - Dissolve 1 troche under tongue nightlyQuantitySecretagogue - Ipamorelin Vial & TrocheSelect Correct OptionIpamorelin - 9 mg vial - Inject 20 units (250 mcg) or 0.2 ml nightly on an empty stomach. 6ml bacteriostatic waterIpamorelin - 300 mcg- Dissolve 1 (300 mcg) troche under tongue or side of cheek at bedtime nightlyQuantitySecretagogue - MK-677Select correct optionIbutamoren Mesylate (MK-677) 25mg Capsule - Take 1 capsule dailyQuantitySecretagogue - Sermorelin VialSelect correct optionSermorelin - 15 mg vial - Inject 10(250mcg) units 0.1 ml nightly on empty stomach. Reconstitute with 6ml Bac WaterSermorelin - 15 mg vial - Inject 20(500mcg) units 0.2 ml nightly on empty stomach. Reconstitute with 6ml Bac WaterQuantitySecretagogue - Sermorelin TrocheSelect correct optionSermorelin - 400 mcg- Dissolve 1 (400 mg) troche under tongue or side of cheek at bedtime nightlyQuantitySecretagogue - Sermorelin / Ipamorelin TrocheSelect Correct OptionSermorelin / Ipamorelin - 300 mcg / 300 mcg - Dissolve 1 troche under tongue nightlyQuantitySildenafil (Viagra)Select correct optionSildenafil (Viagra) 20 MG - Take 1 tablet (20 mg) by mouth 1x daily AS NEEDEDSildenafil (Viagra) 100 MG - Take 1 tablet (100 mg) by mouth 1x daily AS NEEDEDQuantityTadalafil (Cialis)Select correct optionTadalafil (Cialis) 5 mg RDT Tablet - Take 1 tablet (5 mg) 1x daily AS NEEDEDTadalafil (Cialis) 20 mg Tablet - Take 1/4 tablet (5 mg) by mouth 1x daily AS NEEDEDTadalafil (Cialis) 20 mg Tablet - Take 1/2 tablet (10 mg) by mouth 1x daily AS NEEDEDTadalafil (Cialis) 20 mg Tablet - Take 1/2 tablet (10 mg) by mouth every other dayTadalafil (Cialis) 20 mg Tablet - Take 1 tablet (20 mg) by mouth 1x daily AS NEEDEDTadalafil (Cialis) 20 mg Tablet - Take 1 tablet (20 mg) by mouth every other dayTadalafil (Cialis) 25 mg Troche - Dissolve 1 troche (25 mg) under tongue 1x daily AS NEEDEDQuantityTamoxifenSelect correct optionTamoxifen 20 MG - Take 1 tablet (20 mg) by mouth daily AS NEEDEDTamoxifen 20 MG - Take 1 tablet (20 mg) by mouth 2x weekly AS NEEDEDQuantityTest/Cyp - REPLACEMENT VIAL - ORDER DEPT ONLYSelect correct optionREPLACEMENT VIAL - Test/Cyp 200 MG/mL - 5 mL - Inject 0.3 mL by intramuscular route 2x weeklyREPLACEMENT VIAL - Test/Cyp 200 MG/mL - 5 mL - Inject 0.5 mL by intramuscular route 2x weeklyREPLACEMENT VIAL - Test/Cyp 200 MG/mL - 10 mL - Inject 0.5 mL by intramuscular route 2x weeklyQuantityTest/Cyp/Prop - REPLACEMENT VIAL - ORDER DEPT ONLYSelect correct optionTest/Cyp/Prop 180/20 MG/mL - 20 mL - Inject 1 mL by intramuscular route 2x weeklyQuantityTest/Enanthate - REPLACEMENT VIAL - ORDER DEPT ONLYSelect correct optionTest/Enanthate 200 MG/mL - 5 mL - Inject 0.5 mL by intramuscular route 2x weeklyTest/Enanthate 200 MG/mL - 10 mL - Inject 0.5 mL by intramuscular route 2x weeklyTest/Enanthate 200 MG/mL - 10 mL - Inject 1 mL by intramuscular route 2x weeklyQuantityHiddenTest/Prop - REPLACEMENT VIAL - ORDER DEPT ONLYSelect correct optionSelect Correct OptionTest/Prop 200 MG/mL - 10 mL - Inject 0.5 mL by intramuscular route 2x weeklyTest/Prop 200 MG/mL - 10 mL - Inject 1 mL by intramuscular route 2x weeklyTest/Prop 200 MG/mL - 5 mL - Inject 0.5 mL by intramuscular route 2x weeklyHiddenQuantityT3 Liothyronine TabletsSelect correct optionLiothyronine (T3) 25 MCG - Take 1 tablet (25 mcg) by mouth in the AMQuantityT4 Levothyroxine Capsules (25mcg)Select correct optionLevothyroxine (T4) 25 MCG - Take 1 capsule (25 mcg) by mouth in the AMQuantityT4 Levothyroxine Capsules (75mcg)Select correct optionLevothyroxine (T4) 75 MCG - Take 1 capsule (75 mcg) by mouth in the AMQuantityT3/T4 Liothyronine/Levothyroxine CapsulesSelect correct optionLiothyronine/Levothyroxine (T3/T4) 9/38 MCG - Take 1 tablet (9/38 mcg) by mouth in the AMQuantityVitamin D (5000iu/ml)Select correct optionVitamin D (5000 iu/mL) - 10 mL - Inject 0.5 mL by intramuscular route 2x weeklyQuantityMisc and suppliesInsulin Syringes 27g 1/2" (1 bag)Select correct optionSelect Correct OptionInsulin Syringes 27g 1/2" (1 bag)Quantity1 unit = 1 bagInsulin Syringes 29g 1/2" (1 bag)Select correct optionSelect Correct OptionInsulin Syringes 29g 1/2" (1 bag)Quantity1 unit = 1 bagInsulin Syringes 30g 5/16" (1 bag)Select correct optionSelect Correct OptionInsulin Syringes 30g 5/16" (1 bag)Quantity1 unit = 1 bagInsulin Syringes 31g 5/16" (1 bag)Select correct optionSelect Correct OptionInsulin Syringes 31g 5/16" (1 bag)Quantity1 unit = 1 bagIntramuscular Needle/Syringe 3ml - 25g x 1"Select correct optionSelect Correct OptionIntramuscular Needle/Syringe 3ml - 25g x 1"QuantityEXTRA Bacteriostatic WaterSelect correct optionSelect Correct OptionBacteriostatic Water - 30ml vial - Use to reconstitute lyophilized medication as directedQuantityNON TRT PATIENT CONSULTATION FEESelect correct optionSelect Correct OptionNON TRT PATIENT CONSULTATION FEEQuantityPlease enter a number from 1 to 1.Notes/Comments/ Other dosage informationAny other Misc. Products No Yes Any Misc. Products not included aboveTotal Misc. Price Shipping*Choose correct optionFree ShippingHallandale Pharmacy Pick Up (ONLY) - No ChargeShipping ChargeShipping Charge REQUIRES SIGNATUREExpedited Shipping ChargeDiscountTotal $0.00 Discount Price: $0.00 {all_fields}
