Ivermectin/Mebendazole Oral Capsule and FLCCC recommended Supplements purchase form- Prescription NOT Required - Prices as low as $35 for 5 day treatment -Free shipping

How would you like to place this order?

First Name

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Gender

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Body Weight

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Cell Phone Number

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City

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Drug Allergies

(Type "NONE" if no drug allergies) (Separate more than 1 allergies by spaces)

Current Medications

(Type "NONE" if not taking any meds) (Separate more than 1 meds by spaces) (May enter "On File" for repeat orders)

Medical Conditions

(Type "NONE" if there is no long term health condition) (Separate more than 1 conditions by spaces) (May enter "On File" for repeat orders)

Please select the medication(s) you wish to purchase. (Select more than one if applicable)

Select the Reason for Requesting Ivermectin

Select the Reason for Requesting Provider Review (Mebendazole)

Select the Reason for Requesting Ivermectin

Select the Reason for Requesting Mebendazole

Please select your current stage of Cancer

Patient Weight Range

Reason for Provider Review

Find your Estimated Capsule Strength Below

Please tell us the cancer type and stage you are being treated for

Are you currently undergoing any of the following?

Are you COVID-19 Positive?

If positive, Enter the Date when first tested Covid-19 Positive

(Skip this step if you are not covid-19 positive )

Are you requesting Compounded Oral Ivermectin for supportive care in Current/Active or Future Covid-19 infection? (select "Yes" for treatment, and select "No" for requesting for prevention)

Are you requesting Compounded Oral Ivermectin for the Treatment of Long Covid (Long Haulers/ Post Covid condition)? (select "Yes" for Long Covid-19 treatment, and select "No" for requesting for prevention)

Are you requesting Compounded Oral Ivermectin for the prevention of Covid-19 infection?

Are you requesting Compounded Oral Ivermectin capsules for adjunctive treatment of Cancer?

Do you have a history of lice, skin parasites, or itching related to parasite exposure?

What are your current symptoms of parasite infection? Mark all that apply.

I confirm that I am requesting Ivermectin for the treatment or management of suspected or confirmed parasitic infections.

I understand that Ivermectin is FDA-approved for the treatment of certain parasitic infections, including strongyloidiasis and onchocerciasis. I also understand that in some cases, Ivermectin may be prescribed off-label for other conditions as determined appropriate by a licensed provider.

When were you last diagnosed with COVID-19? (Please enter month and year)

What symptoms of Long COVID are you currently experiencing? (e.g., fatigue, brain fog, shortness of breath, chest pain, joint or muscle aches, heart palpitations, insomnia, anxiety, depression, or persistent cough)

I confirm that I am requesting Ivermectin for supportive use related to Long COVID, including symptom management.

I understand that Ivermectin is not FDA-approved for the treatment of Long COVID, and its use in this context is considered off-label and investigational. I acknowledge that currently, no FDA-approved medications exist specifically for Long COVID. I am choosing to proceed with Ivermectin after consultation with a licensed provider. I accept all associated risks and take full responsibility for my treatment choice.

I certify that patient is NOT currently taking the following medications: Warfarin (Coumadin/Jantoven), Sirolimus(Rapamune), Tacrolimus(Advagraf XL, Envarsus XR), Erdafitinib(Balversa), Lasmiditan(Reyvow) Tepotinib(Tepmetko), Erythromycin ethylsuccinate, lactobionate, or stearate, Itraconazole, oral Ketoconazole, or Rifampin(Rifadin)

Applicable only if taking Warfarin or other anticoagulants: I understand that Ivermectin may increase INR levels and raise bleeding risk. I agree to monitor INR and consult my provider if needed.

I certify that patient is at least 18 year of age or older and NOT allergic to Ivermectin.

I certify that patient is NOT pregnant and will not be breastfeeding while taking Ivermectin.

I certify that patient does NOT have Severe Asthma, Severe Liver Disease, hyperactive Onchodermatitis, Concurrent Loiasis or Onchocerciasis (Ivermectin might worsen bronchial asthma)

I agree that patient have reviewed the medication guide on the link below (Most common side effects: dizziness, pruritis (itching on skin), nausea, or diarrhea, joint pain, muscle stiffness, swollen lymph nodes, etc) and low blood pressure, for detailed medication guide, visit: https://medlineplus.gov/druginfo/meds/a607069.html

I confirm that I am requesting Ivermectin for supportive use related to COVID-19, including early outpatient treatment or symptom management.

I and Patient understand that Ivermectin is NOT FDA approved to treat or prevent Covid-19 Infection. I am willing to use Ivermectin at my own risk. Also I and Patient understand that there are FDA authorized therapies are available nearby for treatment of Covid-19 infection such as Paxlovid and Molnupiravir. Patient have consulted with their Primary Care Provider to consider above treatment options before opting to receive oral Ivermectin.

I and patient understand that Ivermectin is NOT FDA approved to treat Cancer, Also there are FDA approved options are available for the treatment of cancer such as Chemotherapy, Radiation, and Immunotherapy. I will continue my oncologist/radiologist recommended treatments and use ivermectin as an add on to my current cancer treatment, but not as a monotherapy.

I confirm that I will inform my oncologist or cancer care provider about my use of Ivermectin and ensure they are monitoring for potential interactions or adverse effects.

I understand that the pharmacy compounds Ivermectin capsules using USP-grade Ivermectin (for oral human use), USP-grade Sodium Bicarbonate, and pharmaceutical-grade gelatin capsules sourced from FDA Inspected Manufacturers and Drug Distributors from USA. I will choose the correct dosage based on my weight group for treatment and/or Prevention for Covid-19 or Cancer.

I and Patient will call their primary care provider if the covid-19 infection gets worse or does not improve. I will call pharmacy if we have any questions on the possible side effects. I will call 911 and seek immediate care if I have trouble breathing, Persistent pain or pressure in the chest, New confusion, Inability to wake or stay awake, Pale, gray, or blue-colored skin, lips, nail beds, depending on skin tone, or oxygen saturation level drops below 94% or any other serious side effects

Have you previously taken Mebendazole?

I confirm that I am requesting Mebendazole as a supportive or adjunctive therapy and not as a standalone or primary treatment for cancer.

I acknowledge that Mebendazole is not FDA-approved for the treatment of cancer and is being used off-label. I understand this usage is experimental and may lack large-scale clinical trial evidence.

I confirm that I will inform my oncologist or cancer care provider about my use of Mebendazole and ensure they are monitoring for adverse effects.

I agree to have my labs checked (CBC, Liver panel, Kidney panel) after 30 days of initiating Mebendazole treatment and have it reviewed by my oncologist or primary care provider.

Do you currently have severe liver disease or have a history of it?

Have you personally seen evidence of parasites on your skin or in your stool?

I confirm that I am requesting Mebendazole for the treatment or management of suspected or confirmed parasitic infections.

I understand that Mebendazole is FDA-approved for the treatment of certain intestinal parasitic infections, such as pinworms, whipworms, hookworms, and roundworms. I also understand that in some cases, Mebendazole may be used off-label for other parasites or broader detox protocols as determined appropriate by a licensed provider.

I confirm that patient is not currently taking Metronidazole (Due to Severe Drug interaction between Metronidazole and Mebendazole)

I confirm that I am not pregnant or breastfeeding while using Mebendazole.

I confirm that I do not have a history of frequent seizures, as Mebendazole may increase neurological risks in these cases.

I confirm that I do not have active or severe liver disease.

I understand that the Mebendazole provided may be custom-compounded using USP-grade ingredients by a licensed pharmacy, and that the dosage will be based on my clinical profile and weight as assessed by a healthcare provider.

I agree to seek immediate medical attention if I experience severe or unexpected symptoms while using Mebendazole, such as rash, fever, jaundice, severe fatigue, or signs of liver stress

I have reviewed the official medication guide at https://medlineplus.gov/druginfo/meds/a682315.html and understand that potential side effects may include, but are not limited to, abdominal pain, diarrhea, headache, dizziness and rash.

I and patient give consent to Medicine Counter pharmacy to prescribe and dispense oral Ivermectin/Mebendazole at my own request and we are bearing all risks. On behalf of myself and patient, my heirs, and personal representatives, I indemnify the organizing body and all persons connected with Medicine Counter from any and all claims that may result from my voluntary request to receive oral Ivermectin/Mebendazole. I also agree that the pharmacy has all rights to refuse and refund any orders for any reasons.

I confirm I have no allergies to Methylene Blue.

Type at least one reason for requesting Methylene Blue (Choose from: Cancer-related support / Depression / Chronic Fatigue Syndrome / Long COVID / Low Energy / Brain Fog) and describe your symptoms with duration.

I confirm that I am not taking any SSRI antidepressant such as sertraline (Zoloft), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), paroxetine (Paxil, Brisdelle), citalopram (Celexa), or fluvoxamine (Luvox).

I confirm that I am not taking any SNRI antidepressant such as venlafaxine (Effexor, Effexor XR), desvenlafaxine (Pristiq), duloxetine (Cymbalta, Drizalma), or levomilnacipran (Fetzima).

I confirm that I am not taking any antidepressant such as mirtazapine (Remeron), trazodone (Desyrel, Oleptro), vortioxetine (Trintellix), vilazodone (Viibryd), nefazodone, amitriptyline (Elavil), clomipramine (Anafranil), or imipramine (Tofranil) and anxiety medication like buspirone (Buspar).

I confirm that I have not taken any MAO-inhibiting medication such as phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), selegiline (Emsam, Eldepryl, Zelapar), rasagiline (Azilect), or safinamide (Xadago) in the past 14 days.

I confirm that I have not received linezolid (Zyvox) or any Methylene Blue treatment or injection in the past 14 days.

I confirm that I am not using any cough or cold medicine containing dextromethorphan (often labeled “DM”), such as Delsym, Robitussin DM, NyQuil DM, DayQuil DM, or store-brand “DM” products.

I confirm that I am not taking any migraine medicine such as sumatriptan (Imitrex), rizatriptan (Maxalt), zolmitriptan (Zomig), eletriptan (Relpax), almotriptan (Axert), frovatriptan (Frova), or naratriptan (Amerge).

I confirm that I am not taking any of the following pain medications: tramadol (Ultram, Ultracet), meperidine (Demerol), methadone (Dolophine), or fentanyl (Duragesic patch, Actiq lozenge, Sublimaze injection).

I confirm that I am not taking any herbal or supplement products that raise serotonin levels such as St. John’s wort, 5-HTP (5-hydroxytryptophan), L-tryptophan, or SAMe (S-adenosyl-methionine).

Mood stabilizers or serotonergic agentsI confirm that I am not taking lithium (Eskalith, Lithobid) or any stimulant that may increase serotonin or interact with MAO inhibition such as amphetamine (Adderall), dextroamphetamine, lisdexamfetamine (Vyvanse), methylphenidate (Ritalin, Concerta), pseudoephedrine (Sudafed), or ephedrine.

I confirm that I do not have a history of G6PD deficiency, hemolytic anemia, or have ever been told that I might be G6PD-deficient.

I confirm that I do not have kidney disease or severe liver disease, and have not been diagnosed with any condition that affects liver or kidney function.

I confirm that I do not have a history of serotonin syndrome, bipolar disorder, mania, psychosis, or uncontrolled anxiety.

I confirm that I have not received intravenous Methylene Blue or taken linezolid (Zyvox) within the past 2 weeks.

Please enter your weight (lbs).

I confirm I am not pregnant or breastfeeding, and I will inform my provider if this changes.

I understand Methylene Blue can act as an MAO-A inhibitor; I will avoid contraindicated serotonergic/MAOI drugs, follow any required washout periods, and not add new interacting meds without provider approval.

I understand all listed uses are off-label, evidence and response can vary, and dosing will be individualized by my provider.

I understand potential effects/side effects: blue-green discoloration of urine/stool/saliva, nausea, abdominal discomfort/diarrhea, headache, dizziness, anxiety/insomnia, elevated BP/HR, skin/mucosa discoloration, and (rarely) hemolysis in G6PD deficiency. I will seek urgent care for symptoms of serotonin syndrome (agitation, confusion, tremor, stiffness, fever, shivering, diarrhea) or hemolysis (dark urine, jaundice, unusual fatigue/shortness of breath).

I understand Methylene Blue can interfere with pulse-oximeter readings; I will inform healthcare providers that I am taking it.

I understand this medicine may be compounded with USP-grade ingredients by a licensed pharmacy, and I will follow the prescribed dose, timing, and duration exactly and report any new medicines or procedures.

I give my full consent for RightMD INC and its affiliated medical/pharmacy teams to prescribe and dispense Methylene Blue capsules based on the information I have provided. I accept all risks and release RightMD INC, its medical, pharmacy, administrative, and all other affiliated teams from any liability related to this treatment.

I confirm that I am not allergic to NSAIDs (e.g., ketoprofen/aspirin), muscle relaxants (baclofen), gabapentin, tricyclics (amitriptyline), or local anesthetics (lidocaine/bupivacaine), or common topical bases (alcohols, parabens, fragrance).

Describe your pain (location(s), duration, typical pain level 0–10, and character such as burning/tingling/electric).

Which areas will you treat, and approximate size of each area (e.g., “palm-sized”)?

I confirm the treatment areas do not have open wounds, broken skin, infection, or severe irritation, and I will not apply to mucosa/eyes.

Do you have numbness or reduced sensation in the planned treatment area(s)?

Are you currently using other pain treatments (topical or oral), including NSAIDs/acetaminophen, anticonvulsants, antidepressants, opioids, muscle relaxants, or other anesthetic creams/patches?

I confirm I am not pregnant or breastfeeding, and I will inform my provider if this changes.

I will apply a thin layer only to intact skin, use the smallest amount needed, wash hands after use, avoid heat/occlusive dressings/tight bandages, and keep away from eyes/mouth/genitals.

I understand potential side effects: local burning/itching/redness/numbness, a very rare allergic reaction or rare heart rhythm issues. I will stop use and seek urgent care for severe or systemic symptoms.

I understand this cream is compounded using USP-grade ingredients and that some components/strengths are off-label for topical neuropathic pain. My dosing (amount/frequency/duration) will be individualized by my provider.

I consent for RightMD INC and affiliated medical/pharmacy teams to prescribe and dispense this compounded neuropathic pain cream based on the information I have provided. I accept all risks and release RightMD INC, its medical, pharmacy, administrative, and all other affiliated teams from any liability related to this treatment.

I confirm that I am not allergic to NSAIDs (e.g., ketoprofen/diclofenac/aspirin), local anesthetics (lidocaine/bupivacaine), gabapentin, peppermint/menthol, or common topical bases (alcohols, parabens, fragrance).

Describe your pain (location(s), duration, typical pain level 0–10, and character such as burning/tingling/electric).

Which areas will you treat (e.g., knees, hands, shoulders), and approximate size of each area (e.g., “palm-sized”)?

I confirm the treatment areas do not have open wounds, broken skin, infection, rash, or severe irritation, and I will not apply to mucosa/eyes.

Are you currently using other pain treatments (topical or oral), including NSAIDs, acetaminophen, opioids, muscle relaxants, nerve agents, or other anesthetic creams/patches?

Are you taking anticoagulants/antiplatelets (e.g., warfarin, DOACs, clopidogrel), or do you have a history of stomach ulcers/bleeding, severe kidney disease, severe liver disease, uncontrolled blood pressure, asthma triggered by NSAIDs/aspirin, heart rhythm problems,arrhythmia,A.Fibrilation, seizures, or heart failure?

Do you have numbness/tingling or reduced sensation in the planned treatment area(s)?

I confirm, I am not pregnant or breastfeeding, and I will inform my provider if this changes.

I will apply a thin layer only to intact skin, use the smallest amount needed, wash hands after use, avoid heat/occlusive dressings/tight bandages on the area, and keep away from eyes/mouth/genitals.

I understand potential side effects: local burning/itching/redness, numbness/tingling, lightheadedness, or very rare allergic reaction. I will stop use and seek urgent care for severe or systemic symptoms.

I understand this cream is compounded using USP-grade ingredients; some components and their strengths are off-label for topical arthritis pain. My dosing (amount/frequency/duration) will be individualized by my provider.

I consent for RightMD INC and affiliated medical/pharmacy teams to prescribe and dispense this compounded arthritis pain cream based on the information I have provided. I accept all risks and release RightMD INC, its medical, pharmacy, administrative, and all other affiliated teams from any liability related to this treatment.

I confirm that I am not allergic to Clindamycin (or related lincosamides like Lincomycin), Tretinoin, Aloe, or common topical bases (e.g., propylene glycol, alcohols, parabens, fragrance).

What is your main goal (e.g., reduce active acne, improve acne scars/texture, both)?

Describe your current skin concerns and how long you’ve had them (e.g., whiteheads/blackheads, inflammatory bumps, post-acne marks).

Which areas will you treat (e.g., face, neck, back, chest)?

Have you previously used topical retinoids (tretinoin/retinol) or topical antibiotics for acne?

Are you currently using other active skincare (e.g., benzoyl peroxide, AHAs/BHAs like glycolic/salicylic acid, azelaic acid, steroids) or had recent peels/laser/microneedling/waxing?

Have you taken oral isotretinoin (Accutane) in the past 6 months?

Have you ever had severe diarrhea or colitis associated with antibiotics (e.g., C. difficile)?

Do you have any medical conditions affecting skin healing or sensitivity (e.g., severe eczema/dermatitis, psoriasis, active rosacea flare, photosensitivity disorders, keloid tendency)?

I confirm the treatment areas do not have open wounds, active infection, or severe irritation, and I will not apply the cream to such areas.

I confirm I am not pregnant or breastfeeding, and I will inform my provider if I plan pregnancy.

I understand tretinoin increases photosensitivity; I will use daily broad-spectrum SPF 30+, limit UV exposure/tanning, and follow nighttime use as directed.

I understand topical clindamycin should be used as directed to reduce antibiotic resistance; I will stop and seek care if I develop severe or persistent diarrhea/abdominal cramps or severe skin irritation.

I will apply a thin layer to intact skin only, avoid eyes/lips/mucosa, wash hands after use, and avoid layering strong actives at the same time unless instructed.

I understand this cream may be compounded using USP-grade ingredients; the specific combination/strengths may be off-label. My instructions (amount/frequency/duration) will be individualized.

I give my full consent for RightMD INC and its affiliated medical/pharmacy teams to prescribe and dispense this compounded acne/acne-scar cream based on the information I have provided. I accept all risks and release RightMD INC, its medical, pharmacy, administrative, and other affiliated teams from liability related to this treatment.

I confirm that I am not allergic to Hydroquinone, Tretinoin, Desonide, Aloe, Vitamin E, Vitamin C, or common topical bases (e.g., propylene glycol, alcohols, parabens, fragrance).

What is your main goal (e.g., fade dark spots, even tone, brighten, texture)?

Describe your current skin concerns (location, duration, possible triggers such as sun exposure, prior acne/melasma, hormones).

Which areas will you treat (e.g., face, neck, décolletage, hands)?

I confirm the treatment areas do not have open wounds, active infection, or severe irritation, and I will not apply the cream to such areas.

Have you previously used Hydroquinone, Tretinoin, or topical corticosteroids?

Are you currently using other active skincare (e.g., benzoyl peroxide, AHAs/BHAs/glycolic/salicylic acid, other vitamin C serums, retinoids, steroids) or had recent peels/laser/microneedling/waxing?

Do you have any medical conditions affecting skin healing or pigment (e.g., severe eczema/dermatitis, psoriasis, active rosacea flare, history of vitiligo or unusual loss of skin color, keloid tendency)?

I confirm I am not pregnant or breastfeeding, and I will inform my provider if I plan pregnancy.

I understand Hydroquinone 4% is intended for targeted dark spots and time-limited use as directed; I will stop and seek care if unusual dark/blue-black patches or severe irritation occur.

I understand Tretinoin 0.025% can increase photosensitivity; I will use daily broad-spectrum SPF 30+, limit UV exposure/tanning, and follow nighttime use as directed.

I understand Desonide 0.05% (low-potency steroid) is for short-term, thin-layer use to reduce irritation; I will avoid prolonged/large-area use, occlusion, or use on infected skin unless directed.

I will follow the application schedule/order provided (do not layer incompatible products unless instructed; avoid use on freshly treated/irritated skin; wash hands after application; avoid eyes/lips/mucosa).

I understand this medication may be compounded using USP-grade ingredients by a licensed pharmacy; my instructions (amount/frequency/duration) will be individualized.

I will stop use and contact my provider if I experience severe irritation, swelling, blistering, rash, dizziness, or any unexpected reaction.

I give my full consent for RightMD INC and its affiliated medical/pharmacy teams to prescribe and dispense this compounded cream based on the information I have provided. I accept all risks and release RightMD INC, its medical, pharmacy, administrative, and other affiliated teams from liability related to this treatment.

I confirm that I am not allergic to Hyaluronic Acid, Vitamin C, Tretinoin, Vitamin E, Aloe, or common topical bases (e.g., propylene glycol, alcohols, parabens, fragrance).

What is your main goal (e.g., soften fine lines, even tone, brighten, texture)?

Describe your current skin concerns and how long you’ve had them.

Which areas will you treat (e.g., face, neck, décolletage)?

I will not apply on Sunburned, open wound, broken/irritated skin or immediately before/after microneedling/procedures without provider guidance.

Are you currently using other active skincare (e.g., benzoyl peroxide, AHAs/BHAs/glycolic/salicylic acid, vitamin C serums, steroids), or had recent peels/laser/microneedling/waxing?

Do you have any medical conditions affecting skin healing or sensitivity (e.g., severe eczema/dermatitis, psoriasis, active rosacea flare, keloid tendency)?

I confirm I am not pregnant or breastfeeding, and I will inform my provider if I plan pregnancy.

I understand tretinoin can increase photosensitivity; I will use daily broad-spectrum SPF 30+, limit UV exposure/tanning, and follow nighttime use as directed.

I will follow the application order and schedule provided (e.g., do not layer incompatible products at the same time unless instructed; avoid use on freshly treated/irritated skin).

I understand this medication may be compounded using USP-grade ingredients by a licensed pharmacy; my instructions (amount/frequency/duration) will be individualized.

I will stop use and contact my provider if I experience severe irritation, swelling, blistering, rash, dizziness, or any unexpected reaction.

I give my full consent for RightMD INC and its affiliated medical/pharmacy teams to prescribe and dispense this compounded anti-aging cream based on the information I have provided. I accept all risks and release RightMD INC, its medical, pharmacy, administrative, and other affiliated teams from liability related to this treatment.

I confirm that I am not allergic to Minoxidil, Finasteride, Tretinoin, or common topical components (e.g., propylene glycol, alcohols, parabens, fragrance).

What is your main goal (e.g., reduce shedding, regrow/thicken hair, maintain density)?

Describe your current symptoms/condition and how long you’ve had them (e.g., recession, vertex thinning, diffuse shedding).

Which scalp areas are affected? (Front, Back, Sides, or all over)

I will not apply on Sunburned, open wound, broken/irritated skin or immediately before/after microneedling/procedures without provider guidance.

Are you using any other hair/scalp treatments now (e.g., topical/oral minoxidil, finasteride/dutasteride, spironolactone, ketoconazole shampoo, steroids, retinoids, PRP/microneedling)?

Have you ever been under care for prostate conditions (e.g., BPH, elevated PSA, prostate cancer) or had unexplained urinary symptoms (weak stream, urgency, night urination)?

I confirm I do not have heart disease, chest pain, arrhythmia, uncontrolled blood pressure, swelling/edema, or severe liver/kidney disease, and I will disclose other significant conditions.

I understand topical Finasteride is off-label; it may lower PSA values and can cause side effects (e.g., decreased libido, erectile/ejaculatory changes, mood changes). I will inform my provider about any PSA testing and report new sexual, breast, testicular, or mood symptoms.

I understand Tretinoin may increase skin sensitivity/irritation and can enhance Minoxidil absorption; I will use only as directed and avoid use on broken/irritated skin.

I will apply only to the scalp as directed, avoid eyes/face, wash hands after use, allow full dry time before bed, and stop/seek care if severe scalp irritation, swelling, dizziness, chest pain, rapid heartbeat, fainting, breast tenderness, or mood changes occur.

I understand benefits may take 3 months of consistent use and early shedding may occur in the first weeks.

I understand this medication may be compounded using USP-grade ingredients by a licensed pharmacy; my instructions (amount/frequency/duration) will be individualized.

I have reviewed treatment information and understand potential side effects: scalp irritation/itching, dryness/dermatitis, unwanted facial/body hair at contact sites, dizziness, fast heartbeat, swelling, sexual or mood changes, breast tenderness, headache.

I give my full consent for RightMD INC and its affiliated medical/pharmacy teams to prescribe and dispense this compounded hair-loss solution based on the information I have provided. I accept all risks and release RightMD INC, its medical, pharmacy, administrative, and other affiliated teams from liability related to this treatment.

I confirm that I am not allergic to Minoxidil, Biotin, Caffeine, Melatonin or any topical product components (e.g., propylene glycol, alcohols,).

What is your main goal for treatment (e.g., reduce shedding, regrow/thicken hair, maintain density)?

Describe your current symptoms/condition and how long you’ve had them (e.g., thinning at crown/part, postpartum shed, diffuse shedding).

Which scalp areas are affected? (Front, Back, Sides, or all over)

Are you using any other hair/scalp treatments now (e.g., topical/oral minoxidil, finasteride/dutasteride, spironolactone, ketoconazole shampoo, steroids, retinoids, PRP/microneedling)?

Do you have any current or past medical conditions (especially heart disease, chest pain, arrhythmia, low blood pressure, edema/swelling, kidney or severe liver disease, thyroid or iron issues, PCOS, major recent illness/surgery)?

I confirm that I am not pregnant or breastfeeding, and I will inform my provider if I plan pregnancy.

I will apply only to the scalp as directed, avoid eyes/face, wash hands after use, allow full dry time before bed, and stop use/seek care if severe irritation, swelling, dizziness, chest pain, rapid heartbeat, or facial hair growth occurs.

I understand that initial increased shedding may occur during the first weeks and that visible benefits may take 3 months of consistent use.

I will not apply on Sunburned, open wound, broken/irritated skin or immediately before/after microneedling/procedures without provider guidance.

I understand this medication may be dispensed as a compounded topical using USP-grade ingredients by a licensed pharmacy; my instructions (amount/frequency/duration) will be individualized.

I agree to seek medical attention if severe side effects occur and to inform my provider about any new medications, pregnancy plans, or procedures affecting the scalp.

I have reviewed treatment information and understand potential side effects (scalp irritation/itching, dryness, dermatitis, unwanted facial hair growth, dizziness, fast heartbeat, swelling, headache).

I give my full consent for RightMD INC and its affiliated medical/pharmacy teams to prescribe and dispense this compounded hair-loss solution based on the information I have provided. I accept all risks and release RightMD INC, its medical, pharmacy, administrative, and other affiliated teams from liability related to this treatment.

I confirm that I am not allergic to Tadalafil or other PDE-5 inhibitors (sildenafil, vardenafil, avanafil) or tablet excipients.

Have you ever taken Tadalafil or other ED medicines before?

Describe your ED concerns and how long you’ve had them.

I confirm I do not have chest pain with exertion/unstable angina, recent heart attack or stroke (past 6 months), severe heart failure, or uncontrolled blood pressure.

Do you use nitrates (nitroglycerin, isosorbide), recreational nitrites (“poppers”), or riociguat? (These must not be combined with Tadalafil)

Are you taking alpha-blockers (e.g., tamsulosin/doxazosin) or other blood-pressure–lowering meds?

Are you taking medicines that may interact (e.g., ketoconazole/itraconazole, ritonavir/cobicistat, clarithromycin/erythromycin, rifampin, carbamazepine/phenytoin, St. John’s wort, or grapefruit products)?

Do you have serious kidney or liver disease?

Do you have retinal disorders (e.g., retinitis pigmentosa) or a history of sudden vision loss/NAION?

History of hearing loss, ringing, or sudden decrease in hearing?

Any penile anatomy issues (e.g., Peyronie’s) or conditions that predispose to priapism (sickle cell disease, leukemia, myeloma)?

Any bleeding disorder or use of anticoagulants/antiplatelets?

I will not use Tadalafil with nitrates/riociguat and will avoid other ED meds within the same 24 hours; I understand nitrates must be avoided for at least 48 hours after Tadalafil.

I will take no more than one dose in 24 hours, use caution with alcohol, and seek emergency care for chest pain—informing clinicians I took Tadalafil (no nitrates).

I understand possible effects (headache, flushing, nasal congestion, indigestion, back pain/muscle aches, dizziness). I will seek urgent care for erection >4 hours, vision/hearing changes, severe dizziness/fainting, or allergic reaction.

I understand tablets may be dispensed as manufactured or compounded; my dosing will be individualized by my provider.

I give my consent for RightMD INC and affiliated teams to prescribe/dispense Tadalafil 10 mg based on my information. I accept all risks and release RightMD INC, its medical, pharmacy, administrative, and all other affiliated teams from any liability related to this treatment.

I confirm that I am not allergic to Sildenafil or other PDE-5 inhibitors (tadalafil, vardenafil, avanafil) or tablet excipients.

Have you ever taken Sildenafil or other ED medicines before?

Describe your ED concerns and how long you’ve had them.

I confirm I do not have chest pain with exertion/unstable angina, recent heart attack or stroke (past 6 months), severe heart failure, or uncontrolled blood pressure.

Do you use nitrates (nitroglycerin, isosorbide), recreational nitrites (“poppers”), or riociguat? (These must not be combined with Sildenafil.)

Are you taking alpha-blockers (e.g., tamsulosin/doxazosin) or other blood-pressure–lowering meds?

Are you taking any medicines that may interact (e.g., ketoconazole/itraconazole, ritonavir/cobicistat, clarithromycin/erythromycin, rifampin, carbamazepine/phenytoin, St. John’s wort, grapefruit products)?

Do you have serious kidney or liver disease?

Do you have retinal disorders (e.g., retinitis pigmentosa) or a history of sudden vision loss/NAION?

History of hearing loss, ringing, or sudden decrease in hearing?

Any penile anatomy issues (e.g., Peyronie’s) or conditions that predispose to priapism (sickle cell disease, leukemia, myeloma)?

Any bleeding disorder or use of anticoagulants/antiplatelets?

I will not use Sildenafil with nitrates/riociguat and will avoid other ED meds within the same 24 hours.

I will take no more than one dose in 24 hours, use caution with alcohol, and seek emergency care for chest pain—informing clinicians I took Sildenafil (no nitrates).

I understand possible effects (headache, flushing, nasal congestion, indigestion, dizziness). I will seek urgent care for erection >4 hours, vision/hearing changes, severe dizziness/fainting, or allergic reaction.

I understand tablets may be dispensed as manufactured or compounded; my dosing will be individualized by my provider.

I give my consent for RightMD INC and affiliated teams to prescribe/dispense Sildenafil 50 mg based on my information. I accept all risks and release RightMD INC, its medical, pharmacy, administrative, and all other affiliated teams from any liability related to this treatment.

I and the patient understand that all treatments, services, and purchases are non-refundable, non-returnable, and non-cancellable. Once an order is placed, the pharmacy will not be able to cancel or refund the order. The pharmacy is not responsible for any delays caused by technical issues or shipping carriers. All sales are final. Medicine Counter Pharmacy will NOT be able to bill any form of insurance for any prescription medications or OTC items purchased. I and the patient agree that we will not seek any reimbursement from Medicine Counter Pharmacy, its employees, or its officers. Payment does not guarantee approval or dispensing of medication. All medications are issued only after clinical review and approval by our licensed pharmacist under a Collaborative Practice Agreement (CPA) with a supervising physician or by our network prescriber. Shipping timeframes begin only after approval and pharmacy processing.

Ivermectin Safety Acknowledgment: I understand that serious side effects from Ivermectin are extremely rare. I agree to stop taking Ivermectin and contact Medicine Counter Pharmacy, my prescriber, or seek medical care right away if I develop concerning symptoms such as confusion, altered mental status, severe dizziness, trouble with balance or coordination, seizure, extreme drowsiness/stupor, blurred vision, bright vision, vision changes, eye pain, chest pain, fast heartbeat, moderate/severe low blood pressure symptoms, trouble breathing, swelling of the face/lips/tongue/throat, hives or severe rash, or unusual bleeding or bruising, especially if I take blood thinners, including blood in urine or stool or bleeding gums.

Mebendazole Safety Acknowledgment:I understand that serious side effects from Mebendazole are extremely rare. I agree to stop taking Mebendazole and contact Medicine Counter Pharmacy, my prescriber, or seek medical care right away if I develop concerning symptoms such as severe rash, blistering or peeling skin, fever, sore throat, unusual or frequent infections, yellowing of the skin or eyes, dark urine, severe abdominal pain, significantly abnormal liver test results, seizure or convulsions, trouble breathing, swelling of the face/lips/tongue/throat, hives, or other signs of a severe allergic reaction.

Medication Name

Purchase Products Below (Ivermectin SHELF LIFE - Although formulation beyond use date (BUD) is normally 6 months by default, However, Ivermectin API powder used expires on 03/2028)

Ivermectin 9mg Capsules

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ID_8378040_I9 IVERMECTIN_9MG_CAPSULE_CAPS

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Ivermectin 12mg Capsules

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ID_8213465_I12 IVERMECTIN_12MG_CAPSULE_CAPS

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Ivermectin 15mg Capsules

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ID_8231535_I15 IVERMECTIN_15MG_CAPSULE_CAPS

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Ivermectin 18mg Capsules

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ID_8385233_I18 IVERMECTIN_18MG_CAPSULE_CAPS

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Ivermectin 21mg Capsules

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ID_8385234_I21 IVERMECTIN_21MG_CAPSULE_CAPS

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Ivermectin 25mg Capsules

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ID_8385235_I25 IVERMECTIN_25MG_CAPSULE_CAPS

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Ivermectin 30mg Capsules

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ID_8213421_I30 IVERMECTIN_30MG_CAPSULE_CAPS

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Ivermectin 35mg Capsules

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ID_8389323_I35 IVERMECTIN_35MG_CAPSULE_CAPS

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Ivermectin 40mg Capsules

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ID_8229652_I40 IVERMECTIN_40MG_CAPSULE_CAPS

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Ivermectin 45mg Capsules

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ID_8388182_I45 IVERMECTIN_45MG_CAPSULE_CAPS

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Ivermectin 50mg Capsules

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ID_8388183_I50 IVERMECTIN_50MG_CAPSULE_CAPS

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Ivermectin 60mg Capsules

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ID_8388184_I60 IVERMECTIN_60MG_CAPSULE_CAPS

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Ivermectin 65mg Capsules

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ID_8388185_I65 IVERMECTIN_65MG_CAPSULE_CAPS

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Ivermectin 3mg Tab by Edenbridge (20 Tablets)

Commercially available Ivermectin 3mg tablet (higher price per mg than compounded capsule) (Will need to take multiple tabs to equal recommended daily dose) (You would only need to take 1 or 2 custom compounded capsule per day)

ID_8279714_IVERMECTIN_3MG_TABLET_TABS

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Mebendazole 110mg Capsules (Parasite Treatment)

Take 1 capsule by mouth twice a day for 3 days on empty stomach for parasite treatment.

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ID_8385236_M110 MEBENDAZOLE IR_110MG_CAPSULE_CAPS

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Mebendazole 220mg Capsules (Non-Aggressive Cancer)

Take 1 capsule by mouth twice a day with fatty food , Recommended for Stage 1 Cancer (Non Aggressive).

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ID_8385237_M220 MEBENDAZOLE IR_220MG_CAPSULE_CAPS

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Mebendazole 300mg Capsules (Aggressive Cancer)

Take 1 capsule by mouth twice a day with fatty food,

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ID_8385238_M300 MEBENDAZOLE IR_300MG_CAPSULE_CAPS

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Ivermectin 1.2% Topical Cream

Ivermectin cream is approved to use for Rosacea, Scabies, lice, and inflammatory lesion (Acne/Pimple Bumps). Not FDA approved for skin cancer, despite anecdotal data and some patients reporting benefits on their skin cancer. Consult your dermatologist before use for cancer.

ID_7828244_FP91 IVERMECTIN_1.20%_CREAM_GM

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Shipping / Pickup Option

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Allow up-to 2-4 business days of processing time to get your order ready and 2-3 business days of shipping transit time. Please refrain from calling the pharmacy for tracking number updates.

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Ivermectin | Mebendazole | Order Form : Prescription is Included (Massive Price Drop: 60% OFF | Limited Time Offer)

* We got a new Website! *

To enhance your experience and provide improved services, we've moved to a new website. Please click the button below to visit our new site and place your order seamlessly.

HOW TO ORDER? (Average time to complete this form is 15 min)

STEP 1: FILL OUT ALL THE INFO

STEP 2: SELECT THE CORRECT DOSAGE BASED ON CONDITION

STEP 3: ENTER THE PAYMENT INFO, SIGN AND SUBMIT

Ivermectin weight based dosage selection (Please read the details below)

Example # 1 (Active Infection): Covid Positive Patient who weighs 185LB: Take 1 capsule of 45mg with food once a day for 5 to 10 days until recovered.

Example # 2 (Covid Prevention): Patient who weighs 220LB and would like to take it for Covid Prevention: Take 1 capsule of 30mg Twice a week while the disease risk is high.

Methylene Blue Capsules

Neuropathic Pain Cream

Arthritis Pain Cream

Acne / Acne Scars Cream

Ultimate Fairness Cream

Umtimate Anti-Aging Cream

Male: Hair Loss Solution

Female: Hair Loss Solution

Tadalafil (Cialis)

Sildenafil (Viagra)

Ivermectin weight based dosage selection (Please read the details below)

Example # 1 (Active Infection): Covid Positive Patient who weighs 185LB: Take 1 capsule of 45mg with food once a day for 5 to 10 days until recovered.

Example # 2 (Covid Prevention): Patient who weighs 220LB and would like to take it for Covid Prevention: Take 1 capsule of 30mg Twice a week while the disease risk is high.

Note: Ivermectin is not FDA-approved for COVID-19 treatment or Prevention. The licensed prescriber may prescribe this as an off-label use based on limited clinical data on a case-by-case basis.

(Aggressive Cancer Treatment, Stage 2, 3 or 4, Metastasized): Patient who weighs 155LB and aggressively treating cancer: Take 1 capsule of 40mg once a day with food for 7-14 days, if tolerated, may increase to 40mg capsule twice a day with food.

(Non Aggressive Cancer Treatment, Stage 1, Non-Metastasized): Patient who weighs 155LB and aggressively treating cancer: Take 1 capsule of 40mg once a day with food.

Note: Ivermectin is not FDA-approved for Cancer Treatment or Prevention. The licensed prescriber may prescribe this as an off-label use based on limited clinical data on a case-by-case basis.

Note: Mebendazole is not FDA-approved for Cancer Treatment or Prevention. The licensed prescriber may prescribe this as an off-label use based on limited clinical data on a case-by-case basis.

(Parasite Treatment): Patient who weighs 155LB: Take 1 capsule of 25mg once a day on an empty stomach for 5 days.

Purchase Products Below (Ivermectin SHELF LIFE - Although formulation beyond use date (BUD) is normally 6 months by default, However, Ivermectin API powder used expires on 03/2028)

Important Notice

Click Submit to Complete the order.

Ivermectin | Mebendazole | Order Form : Prescription is Included (Massive Price Drop: 60% OFF | Limited Time Offer)

*** We got a new Website! ***

To enhance your experience and provide improved services, we've moved to a new website. Please click the button below to visit our new site and place your order seamlessly.

HOW TO ORDER? (Average time to complete this form is 15 min)

STEP 1: FILL OUT ALL THE INFO

STEP 2: SELECT THE CORRECT DOSAGE BASED ON CONDITION

STEP 3: ENTER THE PAYMENT INFO, SIGN AND SUBMIT

*Ivermectin weight based dosage selection (Please read the details below)*

Example # 1 (Active Infection): Covid Positive Patient who weighs 185LB: Take 1 capsule of 45mg with food once a day for 5 to 10 days until recovered.

Example # 2 (Covid Prevention): Patient who weighs 220LB and would like to take it for Covid Prevention: Take 1 capsule of 30mg Twice a week while the disease risk is high.

Methylene Blue Capsules

Neuropathic Pain Cream

Arthritis Pain Cream

Acne / Acne Scars Cream

Ultimate Fairness Cream

Umtimate Anti-Aging Cream

Male: Hair Loss Solution

Female: Hair Loss Solution

Tadalafil (Cialis)

Sildenafil (Viagra)

*Ivermectin weight based dosage selection (Please read the details below)*

Example # 1 (Active Infection): Covid Positive Patient who weighs 185LB: Take 1 capsule of 45mg with food once a day for 5 to 10 days until recovered.

Example # 2 (Covid Prevention): Patient who weighs 220LB and would like to take it for Covid Prevention: Take 1 capsule of 30mg Twice a week while the disease risk is high.

Note: Ivermectin is not FDA-approved for COVID-19 treatment or Prevention. The licensed prescriber may prescribe this as an off-label use based on limited clinical data on a case-by-case basis.

(Aggressive Cancer Treatment, Stage 2, 3 or 4, Metastasized): Patient who weighs 155LB and aggressively treating cancer: Take 1 capsule of 40mg once a day with food for 7-14 days, if tolerated, may increase to 40mg capsule twice a day with food.

(Non Aggressive Cancer Treatment, Stage 1, Non-Metastasized): Patient who weighs 155LB and aggressively treating cancer: Take 1 capsule of 40mg once a day with food.

Note: Ivermectin is not FDA-approved for Cancer Treatment or Prevention. The licensed prescriber may prescribe this as an off-label use based on limited clinical data on a case-by-case basis.

Note: Mebendazole is not FDA-approved for Cancer Treatment or Prevention. The licensed prescriber may prescribe this as an off-label use based on limited clinical data on a case-by-case basis.

(Parasite Treatment): Patient who weighs 155LB: Take 1 capsule of 25mg once a day on an empty stomach for 5 days.

Purchase Products Below (Ivermectin SHELF LIFE - Although formulation beyond use date (BUD) is normally 6 months by default, However, Ivermectin API powder used expires on 03/2028)*

Important Notice

Click Submit to Complete the order.

* We got a new Website! *

Ivermectin weight based dosage selection (Please read the details below)

Ivermectin weight based dosage selection (Please read the details below)

Purchase Products Below (Ivermectin SHELF LIFE - Although formulation beyond use date (BUD) is normally 6 months by default, However, Ivermectin API powder used expires on 03/2028)