Physicians' Choice Infusion Pharmacy

Brookwood Medical Clinic, PLLC Rx Form | Amy Shultz MD (Supervising Physician)

Burton, Sherrie, N.P. | Phone: (580) 786-4008 

Name
Address
Please select one option:
Ship to a different address:

Compounded Semaglutide

Please select:
Compound with (must select one):
Sig: Inject/mg

Compounded Tirzepatide

Please select:
Compound with:
Sig: Inject/mg
Diagnosis
Additional Longevity Compounds:
Clear Signature
Date / Time

Thank you for choosing Physicians Choice Infusion Pharmacy!

If you have any questions, please call us at 817-993-5448  or send an email to Compounding@pcipharmacy.com .