| # | Order ID | Form | Name of Customer | Address | Status |
|---|---|---|---|---|---|
| 1 |
GO-6902e6fcebeeb854169132
10/30/2025 12:18 |
medicalweightlossclinics.com | David Cheesman | 7548 Alpine Butterfly Ln ORLANDO, Florida - 32819 | awaiting_shipment |
| 2 |
GO-6902e1488131a857723350
10/29/2025 11:53 |
PharmacyChiefs.com | JAIME MCNITT | 7298 Lagae Road, Suite C Castle Pines, Colorado - 80108 | In Process |
| 3 |
GO-6902de820f0b3457810819
10/29/2025 11:41 |
PharmacyChiefs.com | Jenny Etienne | 308 SW 3rd Ave Boynton Beach, Florida - 33435 | In Process |
| 4 |
GO-6902d6e5d2fbe669236401
10/29/2025 11:09 |
avalonaaw.com | LEIF CERVANTES DE REINSTEIN | 256 S WILTON PL LOS ANGELES, CA - 90004 | awaiting_shipment |
| 5 |
GO-6902c14d26909442434839
10/29/2025 09:37 |
PharmacyChiefs.com | Nivea King | 116 Colony Cove Dr. Meridianville, al - 37067 | In Process |
| 6 |
GO-6902aeb611c1d718064758
10/29/2025 08:17 |
Www.telemedicinepractitioners.com | allison rader | 1115 Saddlehorn Bend Angleton, tx - 77515 | awaiting_shipment |
| 7 |
GO-6902a57c280aa971865422
10/29/2025 07:38 |
medicalweightlossclinics.com | Christi FOLEY-ELLINGSON | 15906 CYPRESS HALL DR Cypress, Tx - 77429 | awaiting_shipment |
| 8 |
GO-6902909e6afe8476675013
10/29/2025 06:09 |
gbpharmaceuticals.com | Anthony Schultz | 961 Tropic Blvd Delray Beach, Florida - 33483 | In Process |
| 9 |
GO-690287839ca64387794151
10/29/2025 05:30 |
vestrameds.com | Michelle Twersky | 22021 N. 33rd Pl Phoenix, AZ - 85050 | awaiting_shipment |
| 10 |
GO-690282a5d2ea8696904097
10/29/2025 05:09 |
PharmacyChiefs.com | Sherece West | 3839 Cullingworth Rd Burtonsville, MD - 20866 | In Process |
| # | Order ID | Form | Name of Customer | Address | Status |
|---|
| # | Products | SKU | Title | Qty | Price |
|---|
| Patient Name (First, Last) |
SEX |
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| DOB | Cell Phone | |||||
| Shipping 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) |
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| 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) *
| Doctor Name Goes Here | |
|---|---|
| Docotors' Notes Content Here | Edit |
| # | Order # | Card No. | Amount | Discount Code Discount Type Discount 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 |
|---|
| Patient Name (First, Last) |
SEX |
|
||||
| DOB | Cell Phone | |||||
| Address | ||||||
| Required Patient Information (Fill out or attach demographics with fax) | |
| Allergies (if none, must write none) |
|
| Current Medications (if none, must write none) |
|
| Driver’s License # | |
|
|
|
| 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) *