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Medical Intake Form

Complete the form below to get started. A licensed provider will review your information and determine if GLP-1 therapy is right for you.

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Prescriptions fulfilled by PerfectRx · Flower Mound, TX · (866) 866-6806

AlyverX is a technology platform facilitating access to licensed telehealth providers and licensed pharmacy partners. We do not provide medical care or dispense medications.

Partner Pharmacy

PerfectRx

Office: (866) 866-6806

Email: info@perfectrx.com

5810 Long Prairie Rd
Flower Mound, TX 75028

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We serve all U.S. states excluding Arkansas, Mississippi, and New Jersey.

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