The following page will provide you with all the purchasing options. To make an informed decision, it's important to know your dose. We also require this information to accurately write your prescription for the pharmacy. Please use the form below to determine your dose. You will then be taken to the next screen for the purchasing options

First Name *

Last Name *

Starting weight in pounds *

Current weight in pounds *

Are you experiencing side effects? *

No side effects

Some minor side effects

Side effects to a tolerable degree but I do not need to change my dose

Significant side effects

Medication *

Tirzepatide 20mg/ml

Tirzepatide 10mg/ml

Semaglutide

Retatrutide

Dose in Milligrams (not in units-please locate that on the label next to the amount of units you take) *

0.25mg
0.5mg
1mg
2mg
2.5mg
3mg
3.5mg
4mg
4.5mg
5mg
6mg
6.5mg
7mg
7.5mg
8mg
8.5mg
9mg
9.5mg
10mg
12mg
12.5mg
13mg
13.5mg
14mg
14.5mg
15mg
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Appetite suppression *

I am getting a good amount of appetite suppression
I am getting some appetite suppression which is good enough
I am getting little to no appetite suppression
I am getting too suppressed
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How long have you been on this dose? *

Just one week
2 weeks
More than 2 weeks
I've been off the medication for more than 3 weeks
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Please be aware that if you prefer to commence your membership at a later date, kindly utilize the payment link on that specific date. The day you make the payment through that link will mark the beginning of the recurring charges.

How many units in the syringe (to what line on the syringe do you fill the liquid?)

If you do not know your milligram dose and just clicked to get the form finished please write in the name of the pharmacy and the amount of units and how many mg/ml it says on your bottle.

Pharmacy name (found on the bottle of medication) *

South Lake
Tailor Made Compounding (TMC)
Revive
FarmaKeio
Alchemist 20mg vial (10mg/ml)
Alchemist 60mg vial (20mg/ml)
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