Compounding Excellence
RX Check List
Before shipment, confirm that the prescription is complete, accurate, and authorized. Any discrepancies must be resolved and documented prior to shipment.
Patient's Full Name
Please type your rep's name
Medication
Medication Type
Semaglutide
Tirzepatide
Testosterone Cypionate
NAD+
Sermorelin
Enclomiphene
Other
Medication Type
Does the patient’s name and address match the label?
1
Yes
2
No
Vial (quantity)
vial quantity1
1
2
3
4
5
6
Syringes (quantity)
syringes quantity1
1
2
3
4
5
6
Branded Inserts
1
Wellnow
2
SIPA
3
EONMEDS
4
Overtime
5
Intramuscular Injection Instructions
6
Subq Injection Instructions
Shipping Supplies
1
Styrofoam Box
2
Kangaroo Pack
3
EONMeds Bags/Box
4
Overtime Box
5
Logos Box
Ice Pack Size
1
6oz
2
12oz
3
16oz
4
No Ice
Shipping Service
1
Fedex
2
UPS
Image of the package
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Accepts png, jpeg, pdf
Representative Name
Please type your rep's name
Compounding Excellence
Thank you for completing this verification. Your attention to detail helps ensure accuracy, safety, and compliance.
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