Consultation "*" indicates required fields Step 1 of 9 - GOALS 11% WHAT ARE YOUR GOALS?Check ALL that apply* Energy Weight Loss Perfomance / Lean Help my Deficiency Hormone Balance / Fertility / PCOS Immune Boost Skin Help with Depression General Wellness Mood / Focus / Stress Inflammation Detox Other Email* Enter Email Confirm Email What State do you live in? AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State IS THIS YOUR FIRST HOMEKIT?*New PatientRefill OR Existing PatientFirst Name*Last Name*I agree to receive VITAstir® discount codes and promotional emails, and this agreement isn’t a condition of purchase. I also agree to Privacy Policy and Terms and Conditions. I Agree Height (feet)*Please enter a number from 1 to 9.Please enter just the feet, and then in the next field enter in inches. So if you are 5'11, please enter in 5 this field and 11 in the next field.And Inches*Please enter a number from 0 to 11.Weight (lbs)*Please enter a number from 75 to 1200.BMIWhich options would you like? - (If physician does not approve, this amount will be fully refunded.)Most Popular:NAD+ Injection Homekit - ACTIVATED FORM (25 doses) *SALE* Quantity Price: $175.00 Quantity Glutathione Homekit (10 doses, 30 day supply) *SALE* QuantityThis product contains traces of Vitamin C (ascorbic acid) for balancing ph levels. Price: $99.00 Quantity Tirzepatide Options:OUR TIRZEPATIDE FORMULATION CONTAINS THE FULL DOSE OF TIRZEPATIDE, PLUS GLYCINE AND B12. PLEASE READ THE PRODUCT PAGE FOR MORE INFORMATION. IF YOU HAVE ANY QUESTIONS PLEASE EMAIL US. TIRZEPATIDE IS A TITRATED PRODUCT. IF YOU ARE TAKING IT FOR THE FIRST TIME, YOU MUST START AT THE MONTH 1 DOSE, AND TITRATE UP MONTHLY AS NEEDED. 1st MONTH - Tirzepatide Injection Homekit (4 injections, 28 day supply) Quantity2.5mg per week for 4 weeks (Tirzepatide/Glycine/B12) Price: $185.00 Quantity 2nd MONTH - Tirzepatide Injection Homekit (4 injections, 28 day supply) Quantity5mg per week for 4 weeks (Tirzepatide/Glycine/B12) Price: $299.00 Quantity 3rd MONTH Tirzepatide Injection Homekit (4 injections, 28 day supply) Quantity7.5mg per week for 4 weeks (Tirzepatide/Glycine/B12) Price: $399.00 Quantity 4th Month - Tirzepatide Injection Homekit (4 injections, 28 day supply) Quantity10mg per week for 4 weeks (Tirzepatide/Glycine/B12) Price: $449.00 Quantity 5th Month - Tirzepatide Injection Homekit (4 injections, 28 day supply) Quantity12.5mg per week for 4 weeks (Tirzepatide/Glycine/B12) Price: $499.00 Quantity 6th Month - Tirzepatide Injection Homekit (4 injections, 28 day supply) Quantity15mg per week for 4 weeks (Tirzepatide/Glycine/B12) Price: $599.00 Quantity Skinny Shot Homekit (10 doses, 30 day supply) **SALE $289** QuantityPAIRS WELL WITH TIRZEPATIDE! Price: $289.00 Quantity Lipotropic(MIC)/B12 Homekit (10 doses, 30 day supply) Quantity Price: $85.00 Quantity B12 Homekit (10 doses, 30 day supply) Quantity Price: $75.00 Quantity Fit Shot® Injection HOMEKIT (10 doses, 30 day supply) Quantity Price: $399.00 Quantity GSH High Dose Injection HOMEKIT (15 doses, 30 day supply) QuantityThis product contains traces of Vitamin C (ascorbic acid) for balancing ph levels. Price: $399.00 Quantity Semaglutide Weight Loss Program1 Month Weight Loss Program W/ Powershot Homekit Quantity Price: $899.00 Quantity REFRIGERATED PRODUCTSemaglutide Options:OUR SEMAGLUTIDE INCLUDES A FULL DOSE OF SEMAGLUTIDE PLUS B12. SEMAGLUTIDE IS A TITRATED PRODUCT. IF YOU ARE TAKING SEMAGLUTIDE FOR THE FIRST TIME, YOU MUST START AT THE MONTH 1 DOSE, AND TITRATE UP MONTHLY AS NEEDED. 1st MONTH - Semaglutide/B12 Injection Homekit (4 injections, 28 day supply) Quantity0.25mg per week for 4 weeks Price: $135.00 Quantity 2nd MONTH - Semaglutide/B12 Injection Homekit (4 injections, 28 day supply) Quantity0.5mg per week for 4 weeks Price: $245.00 Quantity 3rd MONTH - Semaglutide/B12 Injection Homekit (4 injections, 28 day supply) Quantity1.0mg per week for 4 weeks Price: $295.00 Quantity 4th MONTH - Semaglutide/B12 Injection Homekit (4 injections, 28 day supply) Quantity1.7mg per week for 4 weeks Price: $345.00 Quantity MAINTENANCE DOSE (ongoing) - Semaglutide/B12 Injection Homekit (4 injections, 28 day supply) Quantity2.4mg per week for 4 weeks Price: $395.00 Quantity PowerShot Homekit (10 doses, 30 day supply) Quantity Price: $359.00 Quantity Biotin Homekit(10 doses, 30 day supply) Quantity Price: $329.00 Quantity GlyNac (Glycine & NAC) Homekit (10 doses, 30 day supply) Quantity Price: $399.00 Quantity L-Carnitine Homekit (10 doses, 30 day supply) Quantity Price: $199.00 Quantity B-Complex Homekit (10 doses, 30 day supply) Quantity Price: $229.00 Quantity Folic Acid Homekit (10 doses, 30 day supply) Quantity Price: $249.00 Quantity NAC (N-Acetylcysteine) HOMEKIT (10 doses, 30 day supply) Quantity Price: $269.00 Quantity B1/B12 (Thiamine/Cyanocobalamin) Homekit (10 doses, 30 day supply) Quantity Price: $199.00 Quantity B5 (Dexapanthanol) Homekit (10 doses, 30 day supply) Quantity Price: $159.00 Quantity Balance Homekit (10 doses, 30 day supply) (REG $659, SALE $499) Quantity Price: $499.00 Quantity Vitamin C Homekit (10 doses, 30 day supply) Quantity Price: $189.00 Quantity Immune Boost Homekit (10 doses, 30 day supply)**SALE** Quantity Price: $399.00 Quantity Skin Bright Homekit (10 doses, 30 day supply) **SALE** Quantity Price: $349.00 Quantity Vitamin D Homekit (10 doses, 30 day supply) Quantity Price: $299.00 Quantity Bremelanotide Homekit (8 doses, 30 day supply) Quantity Price: $599.00 Quantity Current Medication SAMPLES Available:SAMPLE Tirzepatide 1-Dose Injection Homekit (1 injection, 1 week supply) Quantity1 Injection of 2.5mg - Try it before you buy it. This is the first dose of Tirzepatide/Glycine/B12 2.5mg Price: $99.00 Quantity SAMPLE Semaglutide 1-Dose Injection Homekit (1 injection, 1 week supply) Quantity1 Injection of 0.25mg - Try it before you buy it. This is the first dose of Semaglutide/B12 0.25mg Price: $99.00 Quantity Choose a Shipping Option:* FedEx 2-Day (Ships M-F) (PLUS Pharmacy Processing Time2-5 Days) FedEx Overnight (Ships M-Th) (PLUS Pharmacy Processing Time 2-5 Days) FedEx Priority Overnight (Ships M-F and Saturday Delivery) (PLUS Pharmacy processing time 2-5 Days) Coupon (Not Valid for SALE products) NOTESAdd a note (optional)Total (If physician does not approve, this amount will be fully refunded.) Date of Birth*Race*(We ask this because some populations are more susceptible to certain conditions than others.)Sex* Male Female Allergies*Any new allergies?*What is your occupation?*Past Medical and Surgical History*Please fill out as completely as possible.Do you have any of the following conditions?* Fibromyalgia Chronic Fatigue Syndrome Liver or Kidney problems Heart Problems High Blood Pressure Thyroid Issues Hormone Issues Blood Clots Pre/Peri/Post Menopause Cancer Stroke or Seizure None Select All
