Patient Intake Form

LIVEWELLRX 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!

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PLEASE CLICK ON THE LINK BELOW TO SELECT THE CORRECT MEDICAL INTAKE FORM.

CLICK HERE IF YOU PURCHASED SEMAGLUTIDE

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Item added to your cart

Patient Intake Form

LIVEWELLRX 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

CLICK HERE IF YOU PURCHASED SEMAGLUTIDE

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CLICK HERE IF YOU PURCHASED TIRZEPATIDE

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CLICK HERE IF YOU PURCHASED OZEMPIC/WEGOVY & HAVE A PRESCRIPTION

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CLICK HERE IF YOU PURCHASED OZEMPIC/WEGOVY & DO NOT HAVE A PRESCRIPTION

CLICK HERE IF YOU PURCHASED TESTOSTERONE OPTIMIZATION

CLICK HERE IF YOU PURCHASED BLOOD PANEL FOR TESTOSTERONE

CLICK HERE IF YOU PURCHASED GLP-1 WEIGHT LOSS BLOOD PANEL