Thank you for your interest in working with Peter MD. Your application will be reviewed and someone will reach out within 2 weeks.

PHARMACY INFORMATION:

Contact Person's Name and Title *

Contact Person's Email *

Contact Person's Phone *

Name of Pharmacy *

Pharmacy's state licenses *

Location of the pharmacy

What is your availability for a call:

Preferred time slots

Additional Information:

Why do you want to work with PeterMD and how did you hear about us? *

Is the pharmacy a 503A or 503B? *

Do you offer Testosterone and what is the price of one 10ml vial? *

Do you offer anti-aging medications? Peptides? Weight loss? *

What is the process for clinics to submit orders to you? *

How quickly can you have orders out the door? *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.