Lipotropic Form - V LINE AESTHETICS

Basics

Treatment Details

Shipping Address

Last Page

Next, you'll provide some basic information about yourself, your lifestyle, and your medical history. Your doctor will use this information to evaluate your symptoms and, if appropriate, prescribe medication for treatment.

Email Address *

LEGAL FIRST NAME *

LEGAL LAST NAME *

Sex Assigned At Birth *

Male

Female

Birthday *

ZIPCODE *

PHONE number *

Treatment Details
Save 10% with monthly shipments. Cancel at any time.

Lipotropic (MIC) + B12 Shot (Ship Monthly)
10 Shots per month
Billed and shipped monthly for:
~~$229~~

Shipping Address
If prescribed, we need your current home address on file.

ADDRESS LINE 1 *

ADDRESS LINE 2 (OPTIONAL)

CITY *

STATE *

ZIP CODE *

Review Your Treatment

Lipotropic (MIC) + B12 Shot (Ship Monthly)
10 Shots per month
Billed and shipped monthly for:
$179 ~~$229~~

Medical Evaluation
Expedited Shipping
On-Going Provider Care
Total due if prescribed

Included
Included
Included
Included

Hours

Contact

Business Hours:

Social

Social