Submit your symptoms. Your provider reviews and sends your prescription directly to your pharmacy.
What to expect
01Select your concern and answer targeted questions
02Provider reviews within 2–4 business hours
03Prescription sent electronically to your pharmacy
04Follow-up call placed if anything is needed
01Concern
02Symptoms
03Background
04Pharmacy
05Submit
Step 01 of 05
What brings you in?
Select your concern below.
Step 02 of 05
Symptoms
Video visit required
Step 02 of 05 — Lab consent
Hormone panel required
Before we can safely prescribe estrogen, we need to confirm your hormone status. The panel below is required and includes everything needed to personalize your treatment.
THE MDRN RX Hormone Panel
Performed at any Quest Diagnostics location near you
30-min video consult — review results & discuss your plan+ $65
Optional. Your provider will review labs and contact you either way. A video consult lets you ask questions in real time.
Medication pricing — MediVera pharmacy
Compounded HRT ships directly to your home. We typically start with a single ingredient until your dose is dialed in based on labs and how you feel — this prevents waste and makes adjustments easier.
Estrogen cream — 1 ingredient
30 days $30–$6190 days $137
Testosterone cream — 1 ingredient
30 days $6390 days $140
Estrogen + testosterone cream — 2 ingredients
30 days $6490 days $144
Progesterone capsules
30 days $6090 days $135
Progesterone can also be sent to your preferred local pharmacy if it's cheaper through your insurance.
Visit total$85
Medication pricing is separate from your visit fee and billed directly through MediVera at time of shipment.
Step 03 of 05
Medical background
Current conditions
Select all that apply *
Describe
Medications & allergies
Current medications *
Drug allergies *
Reproductive health
Biological sex *
Pregnancy status *
Certain conditions require a video visit if you are pregnant or possibly pregnant.
Last menstrual period (LMP)
Step 04 of 05
Pharmacy & pricing
Preferred pharmacy
Pharmacy name *
City and zip *
Your prescription will be sent electronically. You will receive a notification once it is on its way.
Labs — Quest Diagnostics
Your provider will review your intake and place the appropriate lab order, sent directly to Quest. Bring a urine sample and allow for a blood draw at your nearest Quest location. No fasting required.
Urine tests
Gonorrheaurine
Chlamydiaurine
Trichomonasurine
Blood tests
Syphilisblood
HSV 1 & 2blood
Hepatitis B & Cblood
HIVblood
How would you like to pay for labs?
Lab costs are separate from your visit fee and paid directly to Quest. Your provider will notify you when results are ready.
Labs required — UTI
Before starting antibiotics, please drop off a urine sample at your nearest Quest Diagnostics. This ensures accurate results — antibiotics can interfere with culture growth and lead to incorrect treatment.
Urinalysis with microscopy
Detects infection markers, blood, bacteria
~$35
Urine culture with sensitivities
Identifies bacteria and confirms antibiotic coverage
~$55
How would you like to pay for labs?
Your provider will place the lab order and send it directly to Quest Diagnostics. You will receive a notification when the order is ready — simply bring a urine sample to your nearest Quest location.
Drop off sample before taking antibiotics
Antibiotics can interfere with culture growth and lead to inaccurate results. Drop off your sample first — your Rx will be ready and waiting. Results return within 24–48 hours. Your provider will follow up if any treatment adjustments are needed.
Medication delivery
📦
Ships to your home via MediVera
Your prescription is compounded and shipped directly to your address. No pharmacy pickup needed.
Visit summary
Total due today$45
Payment collected securely at checkout. Visit fee is non-refundable once your provider begins review.
Medication pricing — MediVera pharmacy
We typically start with a single ingredient until your dose is dialed in based on labs and how you feel — this prevents waste and makes adjustments easier.
Estrogen cream — 1 ingredient
30 days $30–$6190 days $137
Testosterone cream — 1 ingredient
30 days $6390 days $140
Estrogen + testosterone — 2 ingredients
30 days $6490 days $144
Progesterone capsules
30 days $6090 days $135
Can also be sent to your local pharmacy if it's cheaper through your insurance.
Medication pricing is separate from your visit fee and billed directly through MediVera at time of shipment.
Medication is $200/month until your dose reaches 7.65mg, then $250/month as the dose increases. Each vial expires 28 days after opening. If medication remains when your dose changes, you may choose to use it before opening the next vial — discuss with your provider.
Week
Weekly dose
Vial
Cost
1 – 4
2.4 mg
20mg vial
$200
5 – 6
4.8 mg
20mg vial
$200
7 – 9
4.8 – 7.65 mg
20mg vial
$200
10 – 13
7.65 – 10.2 mg
34mg vial
$250
14 – 17
10.2 – 12.75 mg
34mg vial
$250
18 – 19
12.75 – 15.3 mg
34mg vial
$250
20
15.3 mg
34mg vial
$250
Medication cost is separate from your visit fee and billed directly through MediVera. Each vial expires 28 days after opening regardless of how much remains — vial costs reflect this cadence. Your dose increases gradually as your body adjusts.
Your shipping address will be collected securely through Tebra after your submission is reviewed. Please have it ready when you receive your intake packet.
Step 05 of 05
Review & submit
Step 1 — Complete payment
Payment is required before your visit request can be reviewed. Click below to pay securely through Square.
After payment, Square will send a receipt to your email. Open the email and look for the Receipt # — it will be a short code like XFpm. Enter it below to unlock your submission.
Receipt # *
Your receipt # ties your payment to your visit request.
Step 3 — Acknowledge before submitting
Your provider will review your submission within 2–4 business hours and send your prescription directly to your pharmacy. A follow-up call may be placed if anything is needed.
✓
Visit received.
Your intake has been submitted successfully. Your provider will review your information within 2–4 business hours.
📋 What happens next
Before treatment begins, the following will be sent to you through Tebra — our HIPAA-compliant electronic health records platform:
Consent for treatment
HIPAA Notice of Privacy Practices
Telehealth / async visit consent
Financial policy
🔒 Your privacy
This intake form does not collect any personal identifying information (name, date of birth, address, or insurance). Your identity is verified through your Square payment receipt. All clinical records are stored securely in Tebra, a HIPAA-compliant platform.
⚠️ Important reminder
Please do not share personal identifying information (name, DOB, address, SSN) through this form or any unsecured channel. All demographic information will be collected securely through Tebra.
🏥 Insurance billing
If you selected insurance billing for labs, your insurance information will be collected securely through Tebra after your submission is reviewed. Please note — async visit fees are not covered by insurance and are paid directly through Square. Insurance is accepted for lab orders only. Please have your insurance card ready when you receive your Tebra intake packet.
📞 Questions or concerns?
If you have any questions about your visit or need to follow up, please reach out through your Tebra patient portal once your chart has been created. For emergencies, call 911.