Physicians' Choice Infusion Pharmacy

TM Beauty and Wellness Clinic Form | Dr. Hollie Gaeto  (Supervising Physician)

Name
Address
Shipping
Ship to another address:

Compounded Semaglutide

Semaglutide 5mg/mL 

Vials are supplied in 0.5mL, 1mL, or 2mL

Compound with:
Sig: Inject/mg
Dispense Quantity:

Compounded Tirzepatide

Tirzepatide 15mg/mL 

Vials are supplied in 0.5mL, 1mL, or 2mL.

Compound with:
Sig: Inject/mg
Total Quantity to Dispense:
Diagnosis
Additional Longevity Compounds:
CJC1295/IPA 1mg/1mg/ml Injectable Solution - 2ml vial
Sermorelin 2mg/ml Injectable Solution
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 .