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Elevated Transformations Follow-up
First name
Last name
Are you having any side effects to the medication? If yes, please describe
*
Current Weight
Do you want to increase dose to next tier/dose strength?
*
Yes
No
N/A, I am on the maximum dose
Are you ready for refill? (If 'yes,' we will process your order)
*
Yes
No
May we charge your card on file NOW for your next order?
Yes
No, please send me an invoice
Would you like to speak with the doctor?
*
Yes
No
Submit
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