Name *

First Name

Last Name

Cell Phone Number *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I agree to receiving notifications via text when my supplies are ready for pickup. It usually takes about a week for the pharmacy to process and fulfill my order. *

Agree

Which product would you like to order? *

NAD+ Injectable 200mg ($85)

NAD+ Injectable 600 mg ($225)

M.I.C Super B Injections 10 ml ($125)

Glutathione 10 ml Injections ($125)

BPC-157 Injectable 15 mg ($300)

BPC-157 30 Troches ($250)

Sermorelin/Ipamoreline/Theanine 30 Troche ($250)

CJC/Ipamoreline Injectable 3 ml ($300)

AOD/CJC/Ipamoreline 30 Troches ($250)

PT 141 30 Troches ($250)

Sildenafil/Tadalafil/Apomorphine 30 Troches ($250)

Legal Stuff: Client Privacy Rights. Terms and Conditions: https://docs.google.com/document/d/1lXGSUu3HkHxTQ57BZ5U60n-HWUFEMQhUf4xCT4nJSD8/edit?usp=sharing *

I have read and agree to the terms above