Physicians' Choice Infusion Pharmacy

Eudaimonia Wellness & Beauty Rx Form

Address: 14114 Dallas Pkwy, Suite 310, Dallas, TX 75254| Email: info@eudaimoniawellnessandbeauty.com | Phone: 945.265.7963

Supervising Physician: Stephen Outten, D.O

Representative: Janeisha Mays, APRN, FNP-BC

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

Compounded Semaglutide

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

Compounded Tirzepatide

Strengths of Compounded Tirzepatide (include, but not limited to):2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, etc.

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 .