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Monday to Friday 9:00 AM - 5:30 PM
Saturday and Sunday - Closed
Online Refills
Home
About Us
Products & Services
Prescription Services
Custom Compounding Formulations
Drug Disposal
Patient Care Services
Health & Wellness
Products
Consultation Services
Resources
Contact
Women’s Hormonal Health Consult
Name
(Required)
First
Last
Health Care Number
(Required)
Date of Birth
(Required)
Your Phone
(Required)
Your Email
(Required)
Do you have a family doctor?
(Required)
please choose
yes
no
Who is your doctor?
Family Doctor Clinic phone number
When was the first day of your last menstrul cycle?
Or, date of your hysterectomy?
Comments
Consult Fees
(Required)
I understand the initial consult fee is $295, and each follow-up fee is $75 for this service.
CAPTCHA
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Name
(Required)
First
Last
Health Care Number
(Required)
Date of Birth
(Required)
Your Phone
(Required)
Your Email
(Required)
Do you have a family doctor?
(Required)
please choose
yes
no
Who is your doctor?
Family Doctor Clinic phone number
When was the first day of your last menstrul cycle?
Or, date of your hysterectomy?
Comments
Consult Fees
(Required)
I understand the initial consult fee is $295, and each follow-up fee is $75 for this service.
CAPTCHA
Δ
Name
(Required)
First
Last
Health Care Number
(Required)
Date of Birth
(Required)
Your Phone
(Required)
Your Email
(Required)
Do you have a family doctor?
(Required)
please choose
yes
no
Who is your doctor?
Family Doctor Clinic phone number
Comments
Consult Fees
(Required)
I understand the initial consult fee is $295, and each follow-up fee is $75 for this service.
CAPTCHA
Δ
Name
First
Last
Phone
Email
Reason for Follow-Up
e.g., question, 3-month follow-up, issues
Δ
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