Prescription Checkout | Joi Women's Wellness

Let's start with the basics

First Name*

Last Name*

Email Address*

Phone*

Where should we send your medication?

Address Line 1*

Address Line 2

City*

State*

Zip*

Timezone*

Order Summary

Item

Price

GHK-Cu Skin Cream

$299.00

New Member Discount

-$50.00

ORDER TOTAL:

$249.00

Payment Information

Let's process payment for your prescription, then we'll get you on the path to feeling your best!

Credit Card*

American Express

Discover

MasterCard

Visa

Thank you for your purchase!

Now let’s get some more information so our provider has the information needed to write your prescription. The process should take 3 minutes or less. Click ‘next’ to get started!

What is your date of birth?*

Because of regulations, we need this information to fill your medication at a pharmacy.

What sex were you assigned at birth?*

Because of regulations, we'll need this information to fill your medication at a pharmacy.

Female

Male

Other

How did you hear about Joi?*

Referral Name and/or Email*

Referral Name and/or Email

What are your current height and weight?

Height (feet)*

Height (inches)*

Weight (lbs)*

Do you have a history of drug and/or alcohol abuse?*

Yes

No

Are you currently taking any medications?*

Yes

No

Please list all medications you are currently taking:*

Please list all medications you are currently taking:

Do you have allergies to any medications?*

Yes

No

Please list all medications you are allergic to:*

Please list all medications you are allergic to:

Have you ever had any kind of cancer?*

Yes

No

How long ago did you have cancer, and what type of cancer did you have?*

How long ago did you have cancer, and what type of cancer did you have?

Are you currently pregnant or breastfeeding?*

Yes

No

Have you ever had any of the following conditions?*

Select all that apply.

History of an Eating Disorder

Gallbladder Disease

Pancreatitis

Medullary Thyroid Cancer

MEN Syndrome

None of These

Confirmation & Consent

By selecting "I agree and confirm" you confirm that the information you've provided is true.

In addition, you confirm that you have fully reviewed and agree to the Healthcare Informed Consent, the Authorization and Consent to Participate in Telemedicine/Telehealth Consultation, the HIPAA Notice of Privacy Practices, and the Self Payment Agreement. You confirm that you will allow Sequence to sent you messages electronically. Such communications may include personal information, will not be encrypted, and may be viewed by others with access to your email and/or SMS/MMS text message accounts.