Complete intake
Open the secure Tally form and submit the required treatment information.
Start intake
Begin the intake and deposit flow
The path is simple: complete the intake form, then submit the required $500 deposit. If approved, we follow up from there.
What the intake asks for
- Name
- Phone
- Date of birth
- Current medication and dose
- Last refill date
- Pharmacy
Pricing
$100/month or $1,000/year
$500 deposit required. All prices are in USD.
This is continuity insurance for your recovery.
The deposit starts the intake and onboarding process. It does not guarantee a prescription, diagnosis, or treatment relationship.
Submit deposit
After intake, complete the one-time $500 deposit through Stripe.
Wait for follow-up
We review and reach out shortly with the next step.
Secure handoff
Open the intake form now
If you already finished intake and just need to pay the deposit, use the secondary button below.
Medical disclaimer
This service is provided by a licensed physician. Treatment decisions are made on an individual basis. Use of this service does not guarantee a prescription. All care is subject to applicable laws and clinical judgment.