Hormone Order Form

Watch this to learn how to order your hormones online!

To place an order for hormones please fill out the information below. The RX# (prescription Number) is located on the label of your hormone bottle and is a specific number linked directly to your prescription strength and your patient account.

*Please click “Add to Cart” at the bottom of this page to submit your order*

All hormones filled out with this form will be charged with your card on file and will be shipped together with the remainder of your online order.

To qualify for hormones refills, you must have been seen by a Hall Center practitioner within the last 12 months. If you have not been seen in the last 12 months in person please call us at 310-566-6688 to schedule an appointment!

Patient’s Full Name *

Date of Birth *

Agreement *

By selecting “agree” you consent to pay the full amount of your hormones order which will be charged in our office with your credit card on file. The prices for each hormone order will be our standard retail prices.

To qualify for online order refills you must have been seen in person by a Hall Center Practitioner within the last 12 months.

RX # *

Please enter your RX# (prescription number), which is located on the label of your hormone bottle.

Quantity *

How many bottles of this prescription would you like?

2nd RX# (If necessary)

Quantity of 2nd RX

3rd RX (If necessary)

Quantity for 3rd RX

4th RX# (If necessary)

Quantity for 4th RX

5th RX# (If Necessary)

Quantity for 5th RX

6th RX# (If Necessary)

Quantity for 6th RX