Prescription Forms

We do our best to keep all prescription forms up to date with evolving state regulations & patient HRT needs. We will immediately notify you if there are changes to prescription forms, and all updated changes will be available here. Reminder: Form #1 and Form #2 must be submitted for ALL TCore20™ program orders. Form #3 contains optional upgrades. Please call (216)-273-8700 ext. 1009 if you have any questions. 

Men's Prescription Form #1

Due to new regulations, testosterone must be on a separate form. Please submit this form with EVERY TCore20™ base package order. Form does not have to be submitted if patient is only ordering upgrade products.

Men's Prescription Form #2

Due to new regulations, these products must be on a separate form. Please submit this form with EVERY TCore20™ base package order. Form does not have to be submitted if patient is only ordering upgrade products.

Women's Prescription Form #1

Due to new regulations, testosterone must be on a separate form. Please submit this form with EVERY TCore20™ base package order. Form does not have to be submitted if patient is only ordering upgrade products.

Women's Prescription Form #2

Due to new regulations, these products must be on a separate form. Please submit this form with EVERY TCore20™ base package order. Form does not have to be submitted if patient is only ordering upgrade products.

Unisex Form #3

This form ONLY needs to be submitted if patient is ordering upgrades such as peptides or vitamin/amino acid blends. It is NOT REQUIRED WITH EVERY ORDER.

(216)-273-8700

info@hrtnetwork.com

  • Facebook - White Circle
  • Instagram - White Circle
  • Twitter - White Circle
  • LinkedIn - White Circle

6180 Halle Dr. Suite B

Valley View, OH 44125