Your name Your email Your Phone Subject Current PatientReturning PatientNew Patient Do you need a Refill of your medication? YesNo Do you experience Side any Effects? YesNo Please check any side effects that you may have. Abdominal PainNauseaVomitingConstipationRashDizzinessInjection Site ReactionOthers (Please write on message box) Requested Medication Tirzepatide-SublingualSemaglutide+Glycine+B12 What is your Current Dosage StarterBeginnerModerateStandardHigh DoseI'm not sure What is your Current Dosage Starter 4 units (0.04 mL)Beginner 8 units (0.08 mL)Moderate 18 units (0.18 mL)Standard 30 units (0.30 mL)High Dose 44 units (0.44 mL)I'm not sure Requested Dosage Same DoseNext Lower DoseNext Higher Dose Requested Medication Tirzepatide-SublingualSemaglutide+Glycine+B12 What is your Current Dosage StarterBeginnerModerateStandardHigh DoseI'm not sure What is your Current Dosage Starter 4 units (0.04 mL)Beginner 8 units (0.08 mL)Moderate 18 units (0.18 mL)Standard 30 units (0.30 mL)High Dose 44 units (0.44 mL)I'm not sure Requested Dosage Same DoseNext Lower DoseNext Higher Dose Payment Give me a Call, I will Pay via Card through PhoneI will visit the Office and Pay in Person Your message (optional)
