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Do you consider anything in your medical history to be relevant,
please give details.
If unsure, please ask your regular doctor
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AVAILABLE IN UNITED
STATES ONLY
Services not available
in Arkansas, Illinois, or Florida
You can choose to fill your prescription
and your local United States pharmacy.
In addition you can choose either
Regular or 24 hour Express Service:
You can choose to receive a written
prescription and fill your prescription at most any local United
States pharmacy of your choice or EXPRESS service and have your prescription
called into the local United States pharmacy of your choice.
Our prescriptions can only be
filled at a local United States pharmacy of your choice, they can not be
filled at internet or foreign or Canadian or internet versions of pharmacies.
If you would prefer to receive your medication by mail you can choose to
have your prescription faxed to one of two approved local United States
pharmacies that will mail your medication directly to you. The pharmacy
will contact you and fill the prescription and mail the medication directly
to you. (Medical Wellness Center has no
financial ties to either of these pharmacies. They were chosen for
their outstanding customer service, excellent compounding expertise, and
reliability. They only dispense 100% FDA approved manufactured medications.)
Medical Wellness
Center does not sell or dispense any medications and we are not affiliated
with any pharmacies. For pricing and price comparisons, you need
to contact the pharmacy directly.
1. First choose whether
you want to fill you prescription at your local U.S. pharmacy or at Murray
Avenue Apothecary. Choose only ONE of
these two choices.
Prescription
filled at your local United States pharmacy:
Choose
to fill prescription at your local pharmacy: Please
check here if you are choosing to fill your prescription at your local
United States pharmacy. If you want to purchase your prescription
from your local pharmacy, you then can select whether you want Regular
service and wait 7-15 days to receive your written prescription by mail
or whether you want Express service and your prescription is called into
your local pharmacy in approximately 24 hours.
Murray Avenue Apothecary:
412-421-4996
Murray Avenue Apothecary is a specialized
compounding pharmacy. This pharmacy has excellent pricing, especially for
medications that are not covered by insurance or for those who do not have
insurance. Please check FIRST with the pharmacy in regards to pricing
of the medication. Only if you are choosing to fill your prescription
online and have Murray Avenue Apothecary ship the medication to you
check below:
Authorized
Murray Avenue Apothecary to fill prescription : Please
check here authorizing Murray Avenue Apothecary to fill your prescription.
Your medication will be shipped directly to your shipping address that
you provided to the pharmacy and you will be billed by Murray Avenue Apothecary
for the medication . Medical Wellness Center will only bill you for the
online consultation fee.
If you have any questions
in regards to shipping status and tracking information you need to contact
the pharmacy directly: Murray Avenue Apothecary 412-421-4996.
2. Next after making
this selection then choose whether you want regular service (7-15 days)
or Express 24 hour service.
REGULAR
SERVICE: Consult reviewed within approximately 3-7 business days
and your will receive a written prescription by mail in approximately 7-
15 days which you can take to most any local United States pharmacy of
your choice and fill or your prescription is faxed to Murray Ave Apothecary
in 3-7 days. Processing fee $10.35
EXPRESS
SERVICE: Consult
reviewed and prescription within approximately 24 hours called into most
any local United States pharmacy of your choice or faxed to Murray Avenue
Apothecary. Express processing fee
$20.
Please
check here if you are requesting our EXPRESS review and
processing of your medical evaluation. If approved your
prescription will be called into your LOCAL United States pharmacy
of your choice within 24 hours. If you checked yes and you are approved
you will be billed a $20 express processing fee.
IF YOU
ARE REQUESTING EXPRESS SERVICE CALLED INTO A PHARMACY MAKE SURE YOU ENTER
THE NAME, ADDRESS AND PHONE NUMBER OF YOUR LOCAL UNITED STATES PHARMACY
BELOW
If you are requesting express
service, please enter complete phone# including area code, name and address
of pharmacy where you choose to fill your prescription. If you are
selecting Murray Avenue Apothecary just write in your choice, you
do not need to include phone number. The prescription can only
be called into your local U.S. pharmacy. It can not be called in,
faxed or filled at an internet pharmacy, foreign pharmacy, Canadian pharmacy
or pharmacies such as Drugstore.com or an internet version of a local pharmacy
such as CVS.com etc.
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By submitting this consultation form, I certify: |
I
am am an adult 18 years of age or older and I am a genetic female.
I
have read and agree to Waiver of Liability.
I
understand the side effects of this medication which are tingling, burning,
folliculitis, skin rash, acne in less than 1% of users.
I
understand that Vaniqa is not to be used on any other parts of the body
than the face. I understand that Vaniqa is not a depilatory and I will
have to continue using other methods of hair removal along with Vaniqa
the first several weeks.
I
understand that pregnant and nursing mothers should NOT use Vaniqa.
I
am aware that in order to be eligible to receive a Rx, I must had a physical
examination to rule out any serious underlying causes of hirsutism.
I understand that treating the facial hair does not treat the underlying
condition which may be as serious as Cancer or major Endocrine Disorders.
I need to continue with all my regular primary health care and regular
physical examinations, and I need to inform my doctor that I am taking
Vaniqa.
I
do not have any of the contraindications to therapy and I have read
and understand the contraindications and possible side effects
I
do not have a current prescription for Vaniqa from another physician.
I
understand that my credit card will be billed $49.95 and $10.35 S &
H processing fees for the medical consultation if approved
(no refunds for this consultation service under any circumstances),
if not approved there is NO charge. I understand that by submitting
this form I agree to pay the $49.95 consultation and S& H fees
if approved and understand that there are no refunds for any circumstances
even if I later change my mind and decide not to fill the prescription
I receive or decide not to take the medication for any reason. I
understand that once submitted, my request for a physician consultation
can not be canceled.
Please
check here if you are requesting our EXPRESS (available in
United States only) review and processing of your medical
evaluation. If approved your prescription will be called into
a pharmacy of your choice within approximately 24 hours. If you checked
yes and you are approved you will be billed a $20 express processing
fee.
I
have answered all the questions truthfully and I understand that by clicking
submit I agree to all the terms and conditions including that my credit
card will be charged the above stated amount for the consultation if approved.
Please CONFIRM YOUR SELECTION
made above of receiving written prescription or Express Service called
into local United States pharmacy:
Option
1 : Regular Service - receive written prescription by mail in 7 -15
days or faxed to Murray Ave Apothecary in 3 -7 days.
Option
2 : EXPRESS Service - have prescription called into a local United States
pharmacy or Murray Avenue Apothecary within
approximately 24 hours.
If
selecting express service, make sure you confirm the name and phone number
of
your pharmacy below!
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To contact Advanced Medical Hair Removal - Vaniqa -with
any questions, please Email us. |
PHONE NUMBER:
(US ONLY) |
617-367-8887 |
Medical Wellness Center
Boston, MA
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