First Name

Last Name

Email *

Phone *

State *

Please note that we are not available in the following states right now: AK, CA, DE, HI, MA, MS, NH, NJ, NM, NC, RI and VT

Provider You're Switching From *

Why Do You Want to Switch? *

Sick of syringes, unhappy with customer support, etc.

Proof of Previous Prescription *

All we need is an account screenshot or receipt from a syringe-based provider from the last 90 days. Photos of syringes or vials alone won’t be accepted.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, and new product updates, among others.