New Clinic Signup

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STRIVE RX
E
Welcome to Strive Rx
E
Hi! What's your full name and role at the clinic?
Sure thing!
😎
John
 , 
Doe
E
John
 , 
Doe
😎
Doctor
😎
john@email.com
😎
New Clinic Inquiry Form
Sandstone looking tan earthy texture.
BACK
BACK
Title & Email
NEXT
NEXT
E
STRIVE RX
E
Welcome to Strive Rx
E
Hi! What's your full name and role at the clinic?
Sure thing!
😎
John
 , 
Doe
E
John
 , 
Doe
😎
Doctor
😎
john@email.com
😎
E
Awesome, thanks! Could we get your clinic's name, website, and information?
Intermountain
😎
www.int.com
😎
801-889-7898
😎
801-889-7000
😎
435 S 600 E
😎
#606
😎
St. George
😎
Utah
😎
84770
😎
New Clinic Inquiry Form
Reddish and gold textural element.
BACK
BACK
Clinic Information
NEXT
NEXT
E
STRIVE RX
E
Welcome to Strive Rx
E
Hi! What's your full name and role at the clinic?
Sure thing!
😎
John
 , 
Doe
E
John
 , 
Doe
😎
Doctor
😎
john@email.com
😎
E
Awesome, thanks! Could we get your clinic's name, website, and information?
Intermountain
😎
www.int.com
😎
801-889-7898
😎
801-889-7000
😎
435 S 600 E
😎
#606
😎
St. George
😎
Utah
😎
84770
😎
E
Thank you. We'd love to hear a little more about your clinic to tailor your experience!
John
 , 
Doe
E
Num. of Locations
 : 
Doe
😎
John
 , 
Doe
E
Num. of Prescribers
 : 
Doe
😎
AZ, UT, NYC
😎
CVS, Target, Walmart
😎
New Clinic Inquiry Form
Smoky appearing texture image.
BACK
BACK
Clinic Details
NEXT
NEXT
E
STRIVE RX
E
Welcome to Strive Rx
E
Hi! What's your full name and role at the clinic?
Sure thing!
😎
John
 , 
Doe
E
John
 , 
Doe
😎
Doctor
😎
john@email.com
😎
E
Awesome, thanks! Could we get your clinic's name, website, and information?
Intermountain
😎
www.int.com
😎
801-889-7898
😎
801-889-7000
😎
435 S 600 E
😎
#606
😎
St. George
😎
Utah
😎
84770
😎
E
Thank you. We'd love to hear a little more about your clinic to tailor your experience!
John
 , 
Doe
E
Num. of Locations
 : 
Doe
😎
John
 , 
Doe
E
Num. of Prescribers
 : 
Doe
😎
AZ, UT, NYC
😎
CVS, Target, Walmart
😎
E
Which of these medications/services do you offer?
Hormone Replacement Theraphy
😎
Peptides
😎
Semglutide
😎
Other Sterile
😎
John
 , 
Doe
E
Are you a national or regional Telehealth Company?
 : 
YES
😎
John
 , 
Doe
E
Other Products/Services
 : 
Are you interested in prescribing Semaglutide?
😎
New Clinic Inquiry Form
puffy white clouds in a blue sky background.
BACK
BACK
Services and Medications
MEDICATIONS OFFERED?
Extra OFFERINGS
NEXT
NEXT
E
STRIVE RX
E
Welcome to Strive Rx
E
Hi! What's your full name and role at the clinic?
Sure thing!
😎
John
 , 
Doe
E
John
 , 
Doe
😎
Doctor
😎
john@email.com
😎
E
Awesome, thanks! Could we get your clinic's name, website, and information?
Intermountain
😎
www.int.com
😎
801-889-7898
😎
801-889-7000
😎
435 S 600 E
😎
#606
😎
St. George
😎
Utah
😎
84770
😎
E
Thank you. We'd love to hear a little more about your clinic to tailor your experience!
John
 , 
Doe
E
Num. of Locations
 : 
Doe
😎
John
 , 
Doe
E
Num. of Prescribers
 : 
Doe
😎
AZ, UT, NYC
😎
CVS, Target, Walmart
😎
E
Which of these medications/services do you offer?
Hormone Replacement Theraphy
😎
Peptides
😎
Semglutide
😎
Other Sterile
😎
John
 , 
Doe
E
Are you a national or regional Telehealth Company?
 : 
YES
😎
John
 , 
Doe
E
Other Products/Services
 : 
Are you interested in prescribing Semaglutide?
😎
E
Let us know a little more about your specific needs!
John
 , 
Doe
E
Are you interested in prescribing GLP-1 Products?
 : 
YES
😎
John
 , 
Doe
E
Are you interested in prescribing Semaglutide?
 : 
YES
😎
John
 , 
Doe
E
Minimum number of Semaglutide vials needed per week
 : 
YES
😎
John
 , 
Doe
E
Minimum number of Semaglutide vials needed per month
 : 
YES
😎
New Clinic Inquiry Form
Green organic textural element that looks leafy in nature.
BACK
BACK
Please check all that apply (if any)!
Extra OFFERINGS
If yes, what is the minimum number of Semaglutide vials needed for your patients?
**At this time, due to high demand, Strive Compounding Pharmacy can only guarantee up to 30 vials per week per clinic.
NEXT
NEXT
E
STRIVE RX
E
Welcome to Strive Rx
E
Hi! What's your full name and role at the clinic?
Sure thing!
😎
John
 , 
Doe
E
John
 , 
Doe
😎
Doctor
😎
john@email.com
😎
E
Awesome, thanks! Could we get your clinic's name, website, and information?
Intermountain
😎
www.int.com
😎
801-889-7898
😎
801-889-7000
😎
435 S 600 E
😎
#606
😎
St. George
😎
Utah
😎
84770
😎
E
Thank you. We'd love to hear a little more about your clinic to tailor your experience!
John
 , 
Doe
E
Num. of Locations
 : 
Doe
😎
John
 , 
Doe
E
Num. of Prescribers
 : 
Doe
😎
AZ, UT, NYC
😎
CVS, Target, Walmart
😎
E
Which of these medications/services do you offer?
Hormone Replacement Theraphy
😎
Peptides
😎
Semglutide
😎
Other Sterile
😎
John
 , 
Doe
E
Are you a national or regional Telehealth Company?
 : 
YES
😎
John
 , 
Doe
E
Other Products/Services
 : 
Are you interested in prescribing Semaglutide?
😎
E
Let us know a little more about your specific needs!
John
 , 
Doe
E
Are you interested in prescribing GLP-1 Products?
 : 
YES
😎
John
 , 
Doe
E
Are you interested in prescribing Semaglutide?
 : 
YES
😎
John
 , 
Doe
E
Minimum number of Semaglutide vials needed per week
 : 
YES
😎
John
 , 
Doe
E
Minimum number of Semaglutide vials needed per month
 : 
YES
😎
E
Just a few final things. How does your clinic typically write prescriptions, and are you willing to sign up for and use the LifeFile Portal? (It's the breeziest way to get prescriptions filled.) What are your billing preferences?
John
 , 
Doe
E
Preferred Prescribing Method
 : 
YES
😎
John
 , 
Doe
E
Life Portal Sign up?
 : 
YES
😎
John
 , 
Doe
E
Preferred Prescribing Method
 : 
YES
😎
New Clinic Inquiry Form
White textural object looking like clouds and snow.
BACK
BACK
Prescription and Billing Preferences
Select your current prescription method
Select option
Interested in the LifeFile Portal?
Select option
Bill your patients or your clinic?
Select option
** As a 503a pharmacy, Strive Pharmacy only fills patient specific prescriptions and does not dispense in-office stock
SUBMIT INQUIRY
SUBMIT INQUIRY
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