MIC Injections
Name
Phone
Email
I agree to receive marketing communication from Hamilton Health and Wellness
Send
Scroll to Top
Refill Questionairre
Hi there! Looks like you are ready for a refill. To make sure we are treating you safely, please answer the following questions. Answering ALL of the questions will help us facilitate your refill faster than an incomplete check-in.
Name
Email
Current Weight
Height
Side Effects
yes
no
Have you noticed a decrease in appetite?
yes
no
Requested medication and dose
Changes in medical history
yes
no
What was your last injection date?
Consider the next dose if you have not lost weight, have been hungry before day 7 and tolerated your current dose without side effects. Again, decide based on your appetite suppression, and stay on the lowest effective dose as long as possible. More is not always necessarily better in this case. If requesting a retail medication please indicate the name and address of your pharmacy below
Pharmacy info
Send
Call/Text
Email
Get Care Now
