Puramint Patient Contact

Notice: Puramint does not provide Semaglutide containing prescriptions.
Which option best describes you?*

New ClientCurrent ClientMedical ProfessionalCaregiverOther
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Address

Street Address

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How can Puramint help you today?*

I have a general question.I need a new compounded prescription.I need a hormone consultationI need lab testingI need a supplement recommendationI just want the rewards

What questions do you have?
How should Puramint obtain your prescriptions?
I don't have a compound prescription but I want a compound.I need it transferred from another pharmacy.I need you to contact my doctors officeI have a paper copy of my prescriptionI need my prescriptions transferred and for you to contact my doctor for new prescriptions.Other
Any additional information we may need?
Thank you for your interest in Hormone Consultation.

Let us know a few details in order to most effectively serve you.
Are you here for yourself or somebody else?

MyselfFamily MemberFriendOther
What is your experience using functional medicine?

None (Help me understand Functional Medicine)Basic (I have heard the terms and understand them)Moderate (I use some functional medicine in my wellness journey)Expert (I incorporate functional medicine and natural methods of treatment before seeking out traditional medicine)
Do you currently use compounds?

YesNoI have in the pastWhat is a compound?
What is your chief complaint?
Have you had any labs done within the last 6 months?

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Thank you for your interest in Lab Testing

Let us know some details so we can most effectively serve you.
What type of testing do you need?

Female Hormone Saliva TestingMale Hormone Saliva TestingVitamin DThyroid Function TestsWhat is Saliva Testing?Other
Thank you for your interest in a supplement recommendation.

Let us know some details so we can most effectively serve you.
Select all that apply.

I need help identifying my supplement needs, less than 5 minutes.I would like to have my supplements evaluated to see if I can take fewer pills per day.I want to know if any of my prescription medications can cause nutrient depletion.I would like a full supplement review.Other
Any additional information you would like to convey?

How should we contact you?
Type a question

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Any additional information for the pharmacist?
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Notice: Puramint does not provide Semaglutide containing prescriptions.

What questions do you have?

How should Puramint obtain your prescriptions?

Thank you for your interest in Hormone Consultation.

Thank you for your interest in Lab Testing

Thank you for your interest in a supplement recommendation.

How should we contact you?