Order My Hormone Test Kit or Wellness Starter Kit

Name

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Last

Date Of Birth

Phone

Email

Address

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Address Line 2

City

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What 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) - $50.00
Progesterone (Pg) - $50.00
Testosterone (T) - $50.00
DHEA-S - $50.00
Cortisol (1 sample) - $50.00
Saliva Profile I – Estradiol (E2), Progesterone (Pg), Testosterone (T), DHEA-S, Cortisol (1 sample) - $200.00

How would you like to receive your kit?

I will pick it up from the pharmacy
Please ship it to me +$15

Any 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.