Order My Hormone Test Kit or Wellness Starter Kit Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 3Name *FirstLastDate Of Birth *Phone *Email *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeNextWhat would you like to order? Please select one or more options below. By checking a box, you acknowledge and agree to pay the price and accept the contents of the selected kit(s) that were shared with you by email and may be discussed over the phone.Estradiol (E2) - $50.00Progesterone (Pg) - $50.00Testosterone (T) - $50.00DHEA-S - $50.00Cortisol (1 sample) - $50.00Saliva Profile I – Estradiol (E2), Progesterone (Pg), Testosterone (T), DHEA-S, Cortisol (1 sample) - $200.00How would you like to receive your kit? *I will pick it up from the pharmacyPlease ship it to me +$15NextAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAny notes, requests, or questions?Please confirm before submitting: Options: *I understand that my personal information is protected under HIPAA and will be used only to coordinate care and process my order.I authorize Doctor’s Choice Pharmacy to contact me by phone to confirm my order and collect payment securely.Submit My Request