Patient Pharmacy Request Form

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In order to receive your medicines before running out, make sure to request refills at least 14 business days in advance. Pharmacy is not open on weekends or holidays. This page is for patients of the Alpha Male Medical Institute only. To become a patient, click here.


    First Name

    Last Name

    Email Address

    Phone Number


    Testosterone Cypionate 200mg/ml 4ml vial (2)Sermorelin 6000IUHCG Inj Comp 6000IUAnastrozole 0.5mgAnastrozole 1.0mgTestosterone Cream 4mg/gramArmour Thyroid 30mgFinasteride 1mg18 Gauge Needle 1”1 ml Syringe with 25G 5/8” needle1 Mixing SyringeInsulin SyringeETOH PadsSharps Container

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