Prescription Order Form Data

Patient Details

Name

abc

Address

office address

office city, office state 12345

Map It

Phone

1234567890

Allergies

dicessc

Office Details

Name

office name

Address

office address

office city, office state 12345

Map It

Phone

9876543210

Medical Details

Sermorelin / Ipamorelin

6mg / 6mg

Supplied

Sublingual

CJC / Ipamorelin

6mg / 6mg

Supplied

Injection

SIG

6mg/6mg: 200 mcg sub-Q every day at bedtime

Semaglutide / B6

3mg / 150mg B6/3ml

Supplied

Sublingual

SIG

this is SIG Dosage

AOD- 9604

6mg

Supplied

Injection

SIG

9mg: 300 mg sub-Q every morning 30-45 minutes before first meal of the day for weight loss

Sermorelin/Ipamorelin Oral Solution

15ml

Supplied

Sublingual

SIG
  • Typical dosing: 0.75ml under tongue twice daily. Do not swallow for two minutes