Protocol Packages Order Form

Please use this order form to receive an EMAILED COPY of the most recent protocol package(s). The protocols will be or emailed within the next five business days.
Please enter the required information below:
Email to:
Name (First/Last)
Address
City, State Zip
Daytime Phone
Email Address

Immunization Protocol Package

IMMUNIZATION PROTOCOL PACKAGE COST:

Travel & Rabies Protocol Package

TRAVEL & RABIES PROTOCOL PACKAGE COST:

Nicotine Replacement Therapy Dispensing Protocol Package

NRT DISPENSING PROTOCOL PACKAGE COST:

Long-Acting Injectable Protocol Package

Please select the protocols you wish to purchase. The FULL protocol package includes all 4 long-acting injectable protocols.
Member LAI FULL Protocol Pkg-$50
Member LAI Opioid Antagonist Protocol Pkg-$15
Member LAI Antipsychotic Medications Protocol Pkg-$15
Member LAI Medroxyprogesterone Acetate Protocol Pkg-$15
Member LAI Cobalamin Protocol Pkg-$15
Non-Member LAI FULL Protocol Pkg-$80
Non-Member LAI Opioid Antagonist Protocol Pkg-$20
Non-Member LAI Antipsychotic Medications Protocol Pkg-$20
Non-Member LAI Medroxyprogesterone Acetate Protocol Pkg-$20
Non-Member LAI Cobalamin Protocol Pkg-$20
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