| # | Order ID | Form | Name of Customer | Address | Status |
|---|---|---|---|---|---|
| 1 |
a71160df4c992bc49b8f3d3d71ddba6b1734921256
12/22/2024 09:37 |
back2actionchirorehab.com | Anna Garrison | 1392 East Lark Street Gilbert, AZ - 85297 | For Doctor's Approval |
| 2 |
afc39f1dd85b8c67caef2c10e12781b31734821521
12/21/2024 05:52 |
medicalweightlossclinics.com | NATASHA EHMKE | 612 Neptune Way OCEANSIDE, CA - 92054-2108 | Completed |
| 3 |
afc39f1dd85b8c67caef2c10e12781b31734821371
12/21/2024 05:49 |
medicalweightlossclinics.com | JOSEPH DELVECCHIO | 181 River Rd Bldg #1 Apt. 4G NUTLEY, NJ - 07110 | Completed |
| 4 |
afc39f1dd85b8c67caef2c10e12781b31734821280
12/21/2024 05:48 |
medicalweightlossclinics.com | TRISH TOPPING | 409 Oakcrest Dr PADUCAH, KY - 42001 | Completed |
| 5 |
afc39f1dd85b8c67caef2c10e12781b31734821170
12/21/2024 05:46 |
medicalweightlossclinics.com | ROCIO CORDOVA VALENCIA | 155 S. Court ave apt 1115 ORLANDO, FL - 32801 | Completed |
| 6 |
afc39f1dd85b8c67caef2c10e12781b31734821087
12/21/2024 05:44 |
medicalweightlossclinics.com | SCARLETT NAPOLITANO | 407 N Clara Ave DELAND, FL - 32720 | Completed |
| 7 |
afc39f1dd85b8c67caef2c10e12781b31734821002
12/21/2024 05:43 |
medicalweightlossclinics.com | DEBBIE KUNES | 1014 S Lake Shore Dr FONTANA, WI - 53125 | Completed |
| 8 |
afc39f1dd85b8c67caef2c10e12781b31734820920
12/21/2024 05:42 |
medicalweightlossclinics.com | JOSH RAPKIN | 4 moss point dr ORMOND BEACH, FL - 32174 | Completed |
| 9 |
afc39f1dd85b8c67caef2c10e12781b31734793024
12/21/2024 09:57 |
medicalweightlossclinics.com | CHAD PHARRIS | 419 frost dr, Williams Bay, WI 53191 WILLIAMS BAY, WI - 53191 | Completed |
| 10 |
afc39f1dd85b8c67caef2c10e12781b31734792418
12/21/2024 09:46 |
medicalweightlossclinics.com | ELIZABETH COREY | 1747 Windover Place ST AUGUSTINE, FL - 32092 | Completed |
| # | Order ID | Form | Name of Customer | Address | Status |
|---|---|---|---|---|---|
| 1 |
a71160df4c992bc49b8f3d3d71ddba6b1734921256
12/22/2024 09:37 |
back2actionchirorehab.com | Anna Garrison | 1392 East Lark Street Gilbert, AZ - 85297 | For Doctor's Approval |
| 2 |
0f33ea17195cf35895c96d11aa380a5c1734782918
12/21/2024 07:11 |
thinnex.com | Jeffrey Baker | 959 west ave Suite 17 Miami beach, FL - 33139 | For Doctor's Approval |
| 3 |
1ebd2d5ef8e8b97eac4bc336b2987d051734287094
12/15/2024 01:27 |
gomymeds.com | Hamzah Ramawad | 730 Julia Street 408 New Orleans, LA - 70130 | For Doctor's Approval |
| 4 |
7eb748d87691eac4d570b59ee7109e451731003029
11/07/2024 01:13 |
eyralife.com | TEST TEST | 123 test Maiki, GA - 222333 | For Doctor's Approval |
| 5 |
a1107cb88f05685ef0a71c240b9060cd1730928544
11/07/2024 01:04 |
eyralife.com | Test Test | 123 miami Moamo, AK - 33333 | For Doctor's Approval |
| 6 |
ae605b8ebfc220a5bb8620d3fef005bf1730993478
11/07/2024 10:34 |
changewithrise.com | John Yuhanick | 16108 Baconsfield Lane Monkton, MD - 21111 | For Doctor's Approval |
| 7 |
125322ca0e618079ccd4cf0272c4a3321730944603
11/06/2024 09:00 |
eyralife.com | TEST TEST | 123 test dr Miami, FL - 33325 | For Doctor's Approval |
| 8 |
2acdc3f53dca4df6340a2fe377e4b0711730482025
11/01/2024 01:29 |
theurbanyou.com | Amy Klobucher | 6320 fisk meadow dr rockford, MI - 49341 | For Doctor's Approval |
| 9 |
023d8aec8decd5ac35e7e51fe5bc7edb1730142745
10/28/2024 03:14 |
eyralife.com | TEST TEST | 5257 sw Cooper City, FL - 33328 | For Doctor's Approval |
| 10 |
ca7a15608ce6ae2163f015240c89112c1729293207
10/18/2024 07:16 |
theurbanyou.com | jayne poyner | 20465 Lexington Blvd Northville, MI - 48167 | For Doctor's Approval |
| 11 |
34d8836433d129883d208670f62f6b5d1729108414
10/16/2024 03:55 |
thinnex.com | Test Test | 123 E Example St. Scottsdale, AZ - 85281 | For Doctor's Approval |
| 12 |
835a94e7afe1be842556a98c906f1df21729012677
10/15/2024 01:20 |
eyralife.com | TEST TEST | TEST TEST TEST, FL - 33024 | For Doctor's Approval |
| 13 |
cc090033b28bf0333aae42796835f04b1728749810
10/12/2024 12:19 |
theurbanyou.com | Hannah Earl | 1445 rosalind rd se Grand rapids, MI - 49506 | For Doctor's Approval |
| 14 |
e7d5d871991f949e7211a3da86da05551728588804
10/10/2024 03:36 |
theurbanyou.com | Lynn Diffell | 3435 Lake Dunes Drive Muskegon, MI - 49441 | For Doctor's Approval |
| 15 |
4643d5f7ca854166c0f76f59295796e11728495462
10/09/2024 01:39 |
eyralife.com | Santiago Eljaiek III | 8870 SW 63rd Court Pinecrest, FL - 33156 | For Doctor's Approval |
| 16 |
4a67e7a164e15a671e62dcf942e34d161727559094
09/28/2024 05:38 |
eyralife.com | Docmakori Makoris | 1819 West Ave Bay 6, Miami Beach, FL 33139, United States Miami Beach, AK - 33139 | For Doctor's Approval |
| 17 |
cc52fae8cd87e92d48945370c81350fb1727315498
09/25/2024 09:52 |
changewithrise.com | JAY R MAGDALUYO | 6M CLUSTER 31 CAMBRIDGE VILLAGE, BRGY. SAN ANDRES CAINTA, RIZAL, AK - 1800 | For Doctor's Approval |
| 18 |
6396beb1141285d8b9a2650041d015531727268520
09/25/2024 08:53 |
changewithrise.com | Test Test | 4705 S Adelle Circle Mesa, AZ - 85212 | For Doctor's Approval |
| 19 |
be160ca1703a400206c2930b7f72a0b51727268530
09/25/2024 08:50 |
changewithrise.com | Test Test | 16108 Baconsfield Lane Monkton, MD - 21111 | For Doctor's Approval |
| 20 |
106bde6095af9fec89253c0cd3743ff81725730936
09/07/2024 01:42 |
thinnex.com | Test test | 4705 S Adelle Cir Mesa, AZ - 85212 | For Doctor's Approval |
| 21 |
106bde6095af9fec89253c0cd3743ff81725574622
09/05/2024 06:17 |
thinnex.com | Test Test | 123 Example Mesa, AZ - 85212 | For Doctor's Approval |
| 22 |
1725360477
09/03/2024 06:49 |
trimapill.com | JAY R MAGDALUYO TRIMAPILL | 6M CLUSTER 31 CAMBRIDGE VILLAGE, BRGY. SAN ANDRES CAINTA, RIZAL, AK - 1800 | For Doctor's Approval |
| 23 |
3cf62a547f12b014d067428f49b418931724810979
08/27/2024 10:11 |
gardenia-rx.com | JAY R MAGDALUYO TEST GARDENIA | 6M CLUSTER 31 CAMBRIDGE VILLAGE, BRGY. SAN ANDRES CAINTA, RIZAL, AK - 1800 | For Doctor's Approval |
| 24 |
e67687cd07ddc608a89dc0433fbeb3f41724773663
08/27/2024 11:52 |
gardenia-rx.com | test test | 18000 portofino circle Palm Beach Gardens, FL - 33418 | For Doctor's Approval |
| 25 |
2de728e99e2b5d5bfddff2284b971c321724082584
08/19/2024 11:50 |
thinnex.com | Dimitry Prophete | 1800 North Field Street Building 1, Unit 3509 Dallas, TX - 75202 | For Doctor's Approval |
| 26 |
f3bdd86afcee763cd780d4a6e60a87451724005337
08/18/2024 02:23 |
theurbanyou.com | Test Test | 1309 Coffeen Avenue STE 1200 Sheridan, WY - 82801 | For Doctor's Approval |
| 27 |
45f960efb036ae246bf2ee56fee929c91724004869
08/18/2024 02:15 |
theurbanyou.com | test Test | 4705 S adelle circle MESA, AZ - 85212 | For Doctor's Approval |
| 28 |
3d88e6e46a76a0944a1b2297d9cf558f1724003148
08/18/2024 01:46 |
https://www.alexandriacompounding.com/ | test Test | 1309 Coffeen Avenue STE 4070 MESA, AZ - 85212 | For Doctor's Approval |
| 29 |
832cc51d6ea014b22cdb359f714e87b01723578691
08/13/2024 03:52 |
gardenia-rx.com | TEST TEST | 18000 PORTOFINO CIRCLE palm beach gardens, FL - 33418 | For Doctor's Approval |
| 30 |
832cc51d6ea014b22cdb359f714e87b01723575319
08/13/2024 03:03 |
gardenia-rx.com | TEST TEST | 18000 PORTOFINO CIRCLE palm beach gardens, FL - 33418 | For Doctor's Approval |
| 31 |
b108417c38155222bf0d14cbb48c71231723483272
08/12/2024 01:21 |
thinnex.com | Test Test | 4705 S adelle circle MESA, AZ - 85212 | For Doctor's Approval |
| 32 |
b108417c38155222bf0d14cbb48c71231723482106
08/12/2024 01:02 |
thinnex.com | Test test | 4705 S adelle circle MESA, AZ - 85212 | For Doctor's Approval |
| 33 |
b108417c38155222bf0d14cbb48c71231723090715
08/08/2024 12:19 |
thinnex.com | Test Patient | 4705 S adelle circle MESA, AZ - 85212 | For Doctor's Approval |
| 34 |
b108417c38155222bf0d14cbb48c71231723090563
08/08/2024 12:16 |
thinnex.com | test two | 1234 S adelle circle MESA, AZ - 85212 | For Doctor's Approval |
| 35 |
cf2c38b45180395899862828f5560ac31723090099
08/08/2024 12:10 |
thinnex.com | test test | 4705 S Adelle Cir Mesa, AZ - 85212 | For Doctor's Approval |
| 36 |
0398b4821e075b96bcd5918b00eb43e81723087776
08/07/2024 11:30 |
thinnex.com | Test Test Thinnex | Test Test Test, AK - Test | For Doctor's Approval |
| 37 |
b108417c38155222bf0d14cbb48c71231723057327
08/07/2024 03:03 |
thinnex.com | Test Test | 4705 S adelle circle MESA, AZ - 85212 | For Doctor's Approval |
| 38 |
b108417c38155222bf0d14cbb48c71231723057194
08/07/2024 03:00 |
thinnex.com | test test | 4705 S adelle circle MESA, AZ - 85212 | For Doctor's Approval |
| 39 |
0398b4821e075b96bcd5918b00eb43e81722916996
08/06/2024 12:06 |
thinnex.com | jayr test thinnex 2 | Test Test test, AK - 5611 | For Doctor's Approval |
| 40 |
fdbdaa9540999c52cae899416d1898da1722911144
08/05/2024 10:27 |
thinnex.com | JAY R MAGDALUYO THINNEX TEST | 6M CLUSTER 31 CAMBRIDGE VILLAGE, BRGY. SAN ANDRES CAINTA, RIZAL, AK - 1800 | For Doctor's Approval |
| 41 |
8667104ab377e9242570a7e77acac8381722358007
07/30/2024 12:47 |
DemoAcccount.com | test test | 4705 S adelle circle MESA, AZ - 85212 | For Doctor's Approval |
| 42 |
0052212b096a02f3b2be3c63853142ff1722348260
07/30/2024 10:05 |
Thinnex.com | Test Test | 4705 S adelle circle MESA, AZ - 85212 | For Doctor's Approval |
| 43 |
0052212b096a02f3b2be3c63853142ff1722347273
07/30/2024 09:49 |
Thinnex.com | Test Test | 4705 S adelle circle MESA, AZ - 85212 | For Doctor's Approval |
| 44 |
3e9c4e28e7f297a37545f21566620fa71722332363
07/30/2024 05:41 |
gardenia-rx.com | JAY R TEST AUTH 1 | 6M CLUSTER 31 CAMBRIDGE VILLAGE, BRGY. SAN ANDRES CAINTA, RIZAL, AK - 1800 | For Doctor's Approval |
| 45 |
1721736923
07/23/2024 08:16 |
body4ever.com | Test Test | 4705 S Adelle Circle Mesa, AZ - 85212 | For Doctor's Approval |
| 46 |
b05dc90125b268f1f8ba8edb5168ad221720838753
07/12/2024 10:46 |
gomymeds.com | Test test | 4705 S adelle circle MESA, AZ - 85212 | For Doctor's Approval |
| 47 |
1720543680
07/09/2024 12:51 |
body4ever.com | Amy Bjork | 133 Pineneedle Dr Bradenton, FL - 34210 | For Doctor's Approval |
| 48 |
f77342dc801ace6aad122bd5c653b1f61719966509
07/02/2024 08:32 |
gomymeds.com | Daniel Bonder | 2721 NE 8th terrace Pompano beach, FL - 33064 | For Doctor's Approval |
| 49 |
c1e031fd98f3273073a7155e35524fbb1719349398
06/25/2024 05:04 |
nrish.com | TEST TEST | 2813 N 29TH PL Phoenix, AZ - 85008 | For Doctor's Approval |
| 50 |
64e6b757ed758cb3e00e6ad75f75d8501718309281
06/13/2024 04:08 |
DemoAcccount.com | test test | 116 w geneva dr tempe, AZ - 85281 | For Doctor's Approval |
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* If Provider is a NP/PA a Supervising Provider is required for a Controlled Substance (or a Standing Order must be on file) *
| Doctor Name Goes Here | |
|---|---|
| Docotors' Notes Content Here | Edit |
| # | Order # | Card No. | Amount | Discount Code Type Amount |
Invoice | Invoice Created |
Is Paid | Is Refunded | Payment Status |
|---|
| # | Order # | Prescription Order No. |
Name | Medication | Refill No | Days Supply | Refills | Order Status |
Canceled At |
Tracking No. |
Shipping Provider |
Date Delivered |
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| DOB | Cell Phone | |||||
| Address | ||||||
| Required Patient Information (Fill out or attach demographics with fax) | |
| Allergies (if none, must write none) |
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| Current Medications (if none, must write none) |
|
| Driver’s License # | |
|
|
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| Facility Name | Facility Phone | ||
| Facility Address | |||
* If Provider is a NP/PA a Supervising Provider is required for a Controlled Substance (or a Standing Order must be on file) *