Patient Intake Form

doctor-looking-at-clipboardLiveWellRX Client Medical Intake forms 

To ensure that you receive your prescription  promptly and efficiently, please click on the item you have purchased below and complete the form in its entirety. If you ordered a product that is not listed or required for you to take an intake form. Then you can disregard this page

Your health and well-being are our top priorities, and providing accurate information through this intake process will enable us to deliver the best possible care tailored to your needs.

Thank you for choosing LiveWellRX for your health journey!


Please click on the item you purchased and fill out the form in full to begin your online prescription process.