ACCOUNT FORM

SIGN ACCOUNT FORM

Please complete this account form if you:

  • Would like to start ordering compounds to administer in your office. All new prescriber’s must also complete the Prescriber’s Agreement.
  • Have moved your practice location.
  • Need to update practice information such as practice name, hours of operation, contact emails, or a change in staff.
  • Update billing information.

PRESCRIBER'S AGREEMENT

SIGN PRESCRIBER'S AGREEMENT

Please complete this Prescriber’s Agreement if you:

  • Are a new prescriber and are wanting to administer a compounded product in your office.
  • Would like access to the Prescriber’s Portal.
  • Would like to designate agents to electronically submit prescriptions through the Prescriber’s Portal on your behalf.

Our staff is full of compassionate health care professionals ready to counsel practitioners and patients alike. We’re here to listen to you, research your needs, and provide you with not only medication, but also the knowledge to reach your desired health goals.

Information contained on this site is provided as an informational aide and for reference use only. The content herein is not intended to be, act as, or replace medical advice or diagnosis for individual health conditions nor is it making evaluations as to the risks or benefits of particular preparations. Please consult a licensed healthcare professional about diagnosis and treatment. Information and statements on this site have not been evaluated by the Food and Drug Administration.

CONNECT WITH US

6095 Pine Mountain Rd. NW,
Suite 108
Kennesaw, GA 30152

(800) 547-1399 Ph.
(866) 635-2329 Fax

Hours:
9:00 a.m.-6:00 p.m. M-Th
9:00 a.m.-5:00 p.m. Fri

An account is required to prescribe through our Prescriber Portal.

 

If you would like to access our Prescriber Portal

 

Please choose from one of the options below:

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