SEMAGLUTIDE REORDER FORM  

DO NOT USE THIS FORM IF YOU ARE STARTING THE SEMAGLUTIDE

SEMAGLUTIDE CONSENT

TIRZEPATIDE REORDER FORM   

DO NOT USE THIS FORM IF YOU ARE STARTING THE TIRZEPATIDE 

LIPO INJECTION AND VITAMIN B12 CONSENT FORM  

IV NUTRITION CONSENT FORM  

SEMAGLUTIDE SUBSCRIPTION 

Semaglutide is generic name for Ozempic and Wegovy.

Wegovy is an injectable prescription medicine used for adults who are obese, overweight or someone who also has weight-related medical problems.

This gut hormone has many important metabolic actions including:

•Helping to regulate blood sugar

•Slowing stomach-empyting of food

•Controlling appetite

Significant improvements were also seen in:•Waist circumference•Blood pressure•Blood fats•Inflammation•Physical ability

New patients and patients that have not been seen at our office one year or more will need lab drawn prior to starting Semaglutide or Tirzepatide. You are responsible for knowing your insurance benefits. 

$300 PRE-FILLED SYRINGES (4 WEEKS OF MEDICINE) STOCKED IN OFFICE

$400 (2ML VIAL) New Patient start (7 weeks of medicine to start)

$600 (5 ML VIAL) New Patient start (11 weeks of medicine to start)

• PRICE INCLUDES:
• CONSULTATION
• 4 WEEKS OF SEMAGLUTIDE 
• 7 WEEKS OF SEMAGLUTIDE (DOSES: 0.25MGx 5 wks, 0.5MGx 2 weeks)
• 11 Weeks (0.25mg x 4 weeks, 0.5mg x 4 weeks, 1mg x 3 weeks ) 
• REQUIRED LAB DRAW ADDITIONAL FEE $95 (SELF PAY) NO FEE IF USE INSURANCE
• MINIMUM LAB REQUIREMENTS; (CBC, CMP, lipids, TSH, HGAIC, fasting insulin)

TO GET YOUR VIAL IN TIME FOR YOUR NEXT INJECTION, PLEASE REORDER TWO WEEKS IN ADVANCE.

COMPLETE SEMAGLUTIDE REORDER FORM. CLICK BLUE LINK.

SEMAGLUTIDE REORDER FORM

AN INVOICE WILL BE SENT TO YOUR EMAIL. YOU MUST PAY YOUR INVOICE BEFORE AN ORDER IS PLACED ON YOUR BEHALF.

$200 PRE-FILLED SYRINGES (4 WEEKS OF MEDICINE) STOCKED IN OFFICE, NO WAITING!

$375 (5ml vial) move to higher doses

TO GET YOUR VIAL IN TIME FOR YOUR NEXT INJECTION, PLEASE REORDER TWO WEEKS IN ADVANCE.

COMPLETE SEMAGLUTIDE REORDER FORM. CLICK BLUE LINK.

SEMAGLUTIDE REORDER FORM

AN INVOICE WILL BE SENT TO YOUR EMAIL. YOU MUST PAY YOUR INVOICE BEFORE AN ORDER IS PLACED ON YOUR BEHALF.

$200 PRE-FILLED SYRINGES (4 WEEKS OF MEDICINE) STOCKED IN OFFICE, NO WAITING.

$375 (5ml vial) move to higher doses

TO GET YOUR VIAL IN TIME FOR YOUR NEXT INJECTION, PLEASE REORDER TWO WEEKS IN ADVANCE.

COMPLETE SEMAGLUTIDE REORDER FORM. CLICK BLUE LINK.

SEMAGLUTIDE REORDER FORM

AN INVOICE WILL BE SENT TO YOUR EMAIL. YOU MUST PAY YOUR INVOICE BEFORE AN ORDER IS PLACED ON YOUR BEHALF.

6 WEEKS STARTING DOSE

COST: $550

• PRICE INCLUDES: CONSULTATION and 6 weeks of medicine 

11 WEEKS STARTING DOSE

Cost: $750

• PRICE INCLUDES: CONSULTATION and 11 weeks of medicine (Doses: 2.5mg and 5mg)   

Lab is required to start with Tirzepatide. 

Minimum lab required: CBC, CMP, Lipid panel, TSH, HGAIC, Fasting Insulin. (VIT D LEVEL OPTIONAL)

SELF PAY LAB FEE: $95

NO FEE IF YOU USE INSURANCE FOR THE LAB DRAW. 

5ML VIAL 

COST: $650

5ML VIAL  

COST: $650

5ML VIAL 

COST: $650