Hello Gorgeous Medical Spa

REGEN RX Request

REGEN RX · Compound shop

Shop a protocol.
Request review.

Prices below are what you would pay if prescribed. This is not a cart — you pick what you want, complete screening, and your clinician reviews before any clinic invoice.

01
Pick a protocol
See pack and patient price.
02
Screen
Same medical form. your clinician reviews before anything ships.
03
Invoice after yes
We send a clinic invoice. Then the pharmacy fills.

Peptides & wellness

Sexual health

Skin & hair

Screening · Medical protocol

Complete your
request

We screen you like a medical practice because we are one. your clinician reviews every request before any invoice or fill.

Your request

Refill an existing protocol, or ask to add something new.

Protocol *

About you

So we can match your chart and keep dispensing safe.

Full Name *DOB *Phone *Email *Form requesting refill *Strength / dose currently using *How stored?Missed doses last 2 weeks?Reconstitution date (if applicable)Requesting early? Why?

Indication & Response

Helps us confirm continued benefit.

Original goal / symptom for this medication *Exact % (0-100)

0% No change50%100% Resolved

First noticed benefit *What makes better / worseRe-injury, new injury, surgery, change in activity since last fill?

Safety questions

If you answer yes, tell us a little more so your clinician can review.

Nausea, flushing, dizziness, headache, palpitations?

Swelling at injection site, rash, joint pain, mood change?

ER visit, hospitalization, new diagnosis since last fill?

New allergies or reaction?

Infection, fever, illness last 7 days?

Any other side effects

Medical Update

Changes since last fill affect safety.

New medical conditions?

Pregnant / TTC / breastfeeding? *Weight change?Alcohol per weekNew medications / supplements / peptides? * Include blood thinners, NSAIDs, steroids, other peptides, hormone therapyTaking exactly as directed or changed dose/frequency on own? *

Goals & Consent

Final attestation required.

Goal for next cycle *Questions for provider

I understand this medication is prescribed only if a licensed Illinois clinician decides it is appropriate. Compounded medications are not FDA-approved for this indication. Long-term risks may not be fully known. I am requesting review voluntarily.

Signature * Full legal name

By submitting you confirm this information is accurate. The clinical team reviews every request within 1 business day.