Complete our patient intake form only if you reside in one of the states where our pharmacy is licensed: Arizona, Colorado, Delaware, Florida, Hawaii, Idaho, Illinois, Maine, Missouri, New York, Ohio, Pennsylvania, Rhode Island, South Dakota, Utah, Washington, Wisconsin, or Wyoming.

We do not accept online payments at this time. After we receive and review your intake form, a member of our team will reach out to discuss next steps and payment options.

Your completed form will be forwarded to our panel of licensed prescribers. They will review your condition and, if they determine treatment is appropriate, may issue a prescription. A fee will be charged by the prescriber for this review and prescribing service.

Important: If you do not live in one of the listed states, please do not submit the intake form—we cannot process or fulfill orders outside our licensed states. We recommend consulting a local provider or pharmacy licensed in your area.