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Sick Visit / Chronic Management
Weight Loss Intake Form
✕
Tirzepatide Formulations
Tirzepatide
$
775.00
Tirzepatide B12 or B6 prefilled syringes or vial
$
0.00
Tirzepatide B12 or B6 vial
$
0.00
Tirzepatide pure compounded.
$
0.00
Tirzepatide Sublingual Tablet (ODT)
$
0.00
Tirzepatide/B12 or Tirzepatide/Glycine vial
$
0.00
Tirzepatide/B12 vial
$
0.00
Tirzepatide/B6 vial
$
0.00
Tirzepatide/B6 vial
$
0.00
Tirzepatide/B6 vial
$
0.00
Tirzepatide/B6 vial
$
0.00
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Weight Loss Intake Form
1
$775.00
✕
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