A Simple First Step

Request Your Cream Online

Complete the form to let Doctor’s Choice Pharmacy know which cream you need, and our team will follow up about your request.

Complete the Request Form

Estradiol cream advertisement with pricing

What to Include

Help Us Follow Up on Your Cream Request

Use the form below to submit your cream request. Please provide your name, the best way to reach you, and the name of the cream or any details you have about it. If you have a prescription or questions about your request, mention that in the form so the Doctor’s Choice Pharmacy team can discuss next steps with you.

Estrogen compounded Cream Request

Fill in the form with your contact details and cream information, then submit it. Doctor’s Choice Pharmacy will review your request and follow up using the contact information you provide.\

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Special Estradiol Shortage Offer

Doctor's Choice Pharmacy is offering patient-specific compounded BHRT estradiol cream at special shortage pricing.

1 Month — $40
3 Months — $105

Prescription required. Complete this form and Doctor's Choice Pharmacy can contact your healthcare provider regarding a prescription.

Patient Full Name *

First

Last

Best Phone Number *

Email Address *

Patient Home / Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Required for pharmacy records. If you choose mail delivery, this is the address we will use unless you contact us to provide a different California shipping address.

Are you located in California? *

Doctor's Choice Pharmacy currently serves patients in California.

Choose Your Estradiol Cream Offer *

1 Month — $40
3 Months — $105 — Best Value (Save $15)

Promotional pricing applies to compounded estradiol-only cream. Prescription required.

How would you like to receive your medication? *

Pick Up at Doctor's Choice Pharmacy — No shipping fee
Mail to my California address — +$8 shipping

Pickup: Doctor's Choice Pharmacy, 639 N 13th Ave, Upland, CA 91786. Mail delivery adds $8.

Compounded BHRT Estradiol Cream Offer

1 Month: $40

3 Months: $105 — Save $15

Pickup: No additional fee

Mail Delivery: +$8

Prescription and provider approval are required. Final days' supply depends on the prescribed dose and quantity.

Current Estradiol Product or Patch

Current Estradiol Strength

This information helps our pharmacist communicate with your provider. Your current estradiol dose will not automatically be converted to a compounded cream dose.

Healthcare Provider Information
Doctor's Choice Pharmacy may contact your healthcare provider regarding this request. Your provider must decide whether compounded estradiol cream is appropriate and prescribe the strength and directions.

Healthcare Provider Name *

Provider Office / Practice Name

Provider Phone Number *

Provider Fax Number

Prescription Required *

I understand that compounded estradiol cream requires a valid prescription from an authorized healthcare provider.

Provider Determines Treatment *

I understand that my healthcare provider will determine whether compounded estradiol cream is appropriate for me and will determine the strength, dose, directions, and duration of therapy.

No Automatic Dose Conversion *

I understand that estradiol patches, gels, and compounded estradiol creams are different dosage forms and that my current dose will not automatically be converted to a compounded cream dose.

Authorization to Contact Provider *

I authorize Doctor's Choice Pharmacy to contact my healthcare provider regarding my request for compounded estradiol cream.

Provider Approval Not Guaranteed *

I understand that submitting this request does not guarantee that my healthcare provider will prescribe compounded estradiol cream.

Acknowledgement Phone Not

Compounded Medication Acknowledgement *

I understand that compounded medications are patient-specific preparations and are not FDA-approved products.

Promotional Pricing Scope *

I understand that this promotional pricing applies to compounded estradiol-only cream. Additional hormones, active ingredients, special formulations, or different quantities may have different pricing.

Promotional Price Acknowledgement *

I understand that the promotional price is $40 for approximately a 1-month supply or $105 for approximately a 3-month supply, depending on the dose and quantity prescribed.

Shipping Fee Acknowledgement *

I understand that mail delivery adds an $8 shipping fee.

Address Confirmation *

I confirm that the address I entered is accurate. If I select mail delivery, this address will be used for shipment unless otherwise arranged with the pharmacy.

Do Not Change Current Therapy *

I understand that I should not stop, increase, decrease, or otherwise change my current hormone therapy unless instructed by my healthcare provider.

Communication Consent *

I agree that Doctor's Choice Pharmacy may call me regarding this prescription request.

Optional Text Message Consent

I agree that Doctor's Choice Pharmacy may text me regarding this prescription request. Message and data rates may apply.

Privacy Notice:
The information submitted through this form will be used to respond to your compounded estradiol cream request, maintain appropriate pharmacy records, and communicate with your healthcare provider. Please do not provide additional sensitive medical information unless requested by the pharmacy.

No payment is collected by submitting this form. A valid prescription and provider approval are required before medication can be prepared.

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Phone

(909) 532-5588

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Location

639 N 13th Ave , Upland. Ca 91786

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Email

info@doctorschoicerx.com

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Store Hours

M-F:9am - 5pm
S-S: Closed

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