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Homepage
About us
Client Services
Open Clinic Account
Trimix For ED
Contact us
Careers- Open Positions

✕

Trimix Order/Refill Form

Trimix Order/Refill Form

Welcome to Zion Pharmacy the TRIMIX EXPERTS. In this page you will be able to get resolution for any Trimix issue, including:

Trimix Prescription Order Form For Prescribers
Refill Requests
Upload New Prescriptions
Request Further Information
Request Referral To Local Trimix Prescriber
Order Specialty Trimix Therapy Items like Autoinjectors, Prefilled Syringe Carrier, Cool Transporter and more!

Our staff works diligently to provide prompt responses in real-time or within 1 business day. If you require immediate assistance please call the pharmacy at 954-367-5365.

DO YOU NEED A TRIMIX PRESCRIPTION?
DOWNLOAD THIS PRESCRIPTION FORM FOR YOUR PHYSICIAN TO COMPLETE.

TRIMIX RX FORM FOR DOCTOR

READ MORE ABOUT TRIMIX THERAPY FOR ED

DO YOU NEED TO FILL/REFILL A TRIMIX PRESCRIPTION, NEED A REFERRAL TO A LOCAL TRIMIX PRESCRIBER, OR HAVE QUESTIONS?
USE THIS FORM

CONTACT US HERE FOR TRIMIX ASSISTANCE

Name *

First

Last

Email *

Phone

Physician's Name

Clinic Name

How Can We Help (Check All That Apply)

Prescription Refill
Questions
Fill a New Prescription
Referral To Local Trimix Doctor
Priapism Kits

Prescription/Document Upload

Click or drag files to this area to upload.You can upload up to 4 files.

Please Add The Following Items To My Order (We Will Not Charge Without Phone Confirmation)

Trimix Autoinjector $49.99 ea
Trimix Cool Transporter $45.00 ea
Trimix Cool Transporter W/Additional Cool Pack $55.00 ea
Trimix Prefilled Syringe Carrying Case $22.00 ea (Med Not Included)
Penile Band $22.00 ea
Other (Please Specify Below)

Comments or Instructions

Name

Note

Zion Clinic Pharmacy complies with all the requirements of the Ryan Haight Online Pharmacy Act. Zion Clinic Pharmacy will only dispense a controlled substance to a person who has a valid prescription from a Florida licensed physician issued for a legitimate medical purpose based on a medical relationship with a prescribing practitioner. This includes at least one prior in-person medical evaluation in accordance with applicable requirements of section 309 of the Controlled Substances Act (21 U.S.C. 829). Zion Clinic Pharmacy will not fill any prescription based on an online questionnaire alone.

Due to the nature of the products which involve personal use, there is a strict no return policy.

Legal Notice

The contents of this website are intended for informational use only. It is not intended to or designed to provide medical advice, professional diagnosis, treatment services or to replace your physician’s medical care. Information about the drug products contained on the website does not cover all possible uses, actions, precautions, side effects or interactions. Please consult your medical doctor before making any decisions concerning your health. All medications are compounded in a licensed compounding facility under the direct supervision of licensed pharmacist using FDA approved ingredients and in compliance with Florida State Board of Pharmacy regulations. All products are dispensed for individual patient use pursuant to a patient-specific prescription from a licensed physician.

© 2018 Zion Clinical Pharmacy. All Rights Reserved.

Homepage
About us
Client Services
Open Clinic Account
Trimix For ED
Contact us
Careers- Open Positions

Homepage
About us
Client Services
Open Clinic Account
Trimix For ED
Contact us
Careers- Open Positions