KosherMedications

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Do you have any medication allergies? ( if none type n/a)* This field is required.
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Are you pregnant?* This field is required.
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Not applicable / Male
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Are you currently taking a GLP-1 medication?* This field is required.
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Have you previously participated in a weight loss program* This field is required.
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Do you have a history of acute pancreatitis ?* This field is required.
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Are you currently breastfeeding?* This field is required.
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Medical History (Please check all that apply)* This field is required.
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Upload a picture of all your insurance cards* This field is required.Medical and Pharmacy cards
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ORDER SUMMARY
Total costUSD
1 Month - Compounded Semaglutide
🚀 1-Month Program - Enjoy 24/7 access to your provider via email at support@safer.health or text 718-532-4569.Your order ships monthly and includes all syringes and supplies needed.Benefit from free next-day delivery throughout NY, NJ, CT, and PA.
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3 Month - Compounded Semaglutide
🔥 3-Month Program — $597 ($199/month value) • Billed upfront, shipped monthly • Includes all syringes and supplies • 24/7 provider access via support@safer.health or text 718-532-4569 • Free next-day delivery across NY, NJ, CT, and PA💡 Save $150 vs. monthly — our most popular option for steady results
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6 Month - Compounded Semaglutide
😎 6-Month Program — $1,074 ($179/month value) • Billed upfront, shipped monthly ( any dose) • All syringes and supplies included • 24/7 access to providers at support@safer.health or text 718-532-4569 • Free next-day delivery in NY, NJ, CT, and PA💡 Save $420 — ideal for consistent progress and long-term results
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12 Month - Compounded Semaglutide
💪🏻 12-Month Program — $1,908 ($159/month value) • Billed upfront, shipped monthly (Any dose) • All syringes and supplies included • 24/7 provider access: support@safer.health or text 718-532-4569 • Free next-day delivery across NY, NJ, CT, and PA💡 Save $1,140 — the best value for lasting wellness and complete convenience
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First Name
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H&P Certification* This field is required. Before obtaining your prescription, please review your Health & Physical (H&P) Certification. These statements outline the required self-assessment used to determine prescription eligibility and safety. You can view the full certification details at the link below before completing your purchase.
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Let’s get to know you…* This field is required.Tell Us About Yourself “You need to carefully review each statement below and confirm that you agree. If you have any questions, a licensed provider will contact you after checkout.” ⸻ Compounded Semaglutide Declaration I agree, in the form of a declaration given under oath and penalty of perjury, that I: General Information • am 18 years or older, completing this attestation for myself voluntarily, and have provided accurate demographic information including my name, address, IP address, and physical location from which I am visiting this website, as well as my accurate sex assigned at birth, height, and weight. • will only use this service to seek a prescription for myself, will take the medication as prescribed, and will not share or distribute any medication received. • understand that this attestation will be reviewed and relied upon by a doctor licensed in my state (the “Telehealth Provider”) who will make a prescribing decision in accordance with applicable state and federal laws. • understand that prescribing compounded medications via telemedicine is at the sole discretion of the Telehealth Provider, based on clinical judgment, safety, and appropriateness. • agree that a valid physician–patient relationship is being established through this telehealth technology and may be supplemented by a video or phone visit if medically necessary. • acknowledge that I have reviewed and accept the Consent to Telehealth and Terms & Conditions located at https://koshermedications.com/terms. ⸻ Consent to Telehealth • understand that telehealth is a convenience-based supplemental care model, and should not replace in-person medical visits or ongoing care with my primary provider. • acknowledge that the Telehealth Provider cannot continuously monitor my condition, lab results, or treatment response, and that I assume any risks associated with this model of care. • understand that once the Telehealth Provider issues a prescription, the physician–patient relationship ends at the conclusion of this encounter unless future visits are scheduled. • acknowledge that compounded medications are prepared by licensed compounding pharmacies and are not FDA-approved, though made using FDA-registered ingredients. • consent to the secure electronic transmission of my health information, including to affiliated pharmacies, in compliance with HIPAA. • release KosherMedications.com, its affiliated pharmacy, and the Telehealth Provider from liability for technical failures or data transmission issues. ⸻ Clinical Information About Me (Specific to Compounded Semaglutide) I declare that I: • am seeking compounded semaglutide as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management. • understand that this medication is a compounded formulation that is not FDA-approved, though it is prepared by a licensed pharmacy using ingredients from FDA-registered facilities. • understand the potential risk of thyroid C-cell tumors and have been informed of symptoms such as a lump in the neck, trouble swallowing, shortness of breath, or hoarseness. • do not have a personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN 2). • have not had an allergic or hypersensitivity reaction to semaglutide or any component of this formulation. • am not currently using any other GLP-1 receptor agonist or similar medication. • understand that semaglutide may slow gastric emptying and can affect the absorption of other oral medications. • am aware of the risks of gallbladder disease, pancreatitis, and acute kidney injury, and will promptly report symptoms such as severe abdominal pain, dark urine, yellowing of the skin or eyes, or persistent nausea/vomiting to a healthcare provider. • will monitor for changes in mood or depression, and will report any concerning symptoms to a healthcare provider. • understand that I should not share injection devices and should dispose of them safely. ⸻ My Health Status and Medical History • am in generally good health apart from the condition for which I am seeking treatment. • am not pregnant or breastfeeding. • confirm that I have disclosed all relevant medical conditions, allergies, and medications that could influence the prescribing decision. • understand that the Telehealth Provider may request additional information or a follow-up visit before approving or dispensing the prescription. ⸻ General Information About Prescription Drugs • understand that compounded semaglutide is an off-label formulation, and this attestation does not include all risks or side effects. Additional information can be found at www.fda.gov. • acknowledge that drug interaction information may not be exhaustive, and I am responsible for informing my provider of all other medications, supplements, or herbs I take. • agree to review all patient education materials provided electronically before taking any medication. ⸻ Pharmacy Information • understand that KosherMedications.com works with licensed compounding pharmacies to fill prescriptions as directed by the Telehealth Provider. • acknowledge that the pharmacy and the Telehealth Provider operate independently, and KosherMedications.com does not provide medical care or medical advice. • consent to receive all prescription-related notifications, education, and refill updates electronically. ⸻ Emergency Information • understand that neither KosherMedications.com nor the Telehealth Provider provides emergency medical care. • agree to contact 911 or go to the nearest emergency room in the event of a medical emergency or severe adverse reaction. ⸻ I agree that all statements above are true and accurate, and that my physician visit is complete.
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