Have your patient scan this code to get started on their own device — they can complete the screening questionnaire themselves, wherever they are.
If you’re the patient, simply continue below.
Your recommended formulations
Select the formulation or formulations recommended for you, then complete a short screening.
This short form has three parts: your details, the formulation(s) your clinician recommended, and a brief health screening. The screening helps the compounding pharmacist make sure the formulation is safe and suitable for you before it is prepared. Most questions are simple selections.
Your responses are reviewed by the compounding pharmacist, who may contact you to confirm details, answer any questions and ensure the formulation is suitable before it is compounded and dispatched.
Before we begin, a few details
The compounding pharmacist may contact you directly before dispensing, where appropriate, to confirm your details and make sure the formulation is right for you.
Your delivery address is where your formulation will be shipped once it’s prepared.
Required unless marked optional.
Which formulation(s) has your clinician recommended?
Select all that apply – you can choose from either range.
A few questions about your health
This helps the compounding pharmacist make sure the formulation is safe and suitable for you, taking into account any medications, allergies and health history. Required unless marked optional.
Confirm your answers
Please confirm your responses. Once you continue, you’ll see your recommended formulation.
Your recommended formulation
Based on your responses, your compounding pharmacist will prepare the following. The pharmacist reviews and confirms this before it is dispensed.