AMS Intake
Thank you for your interest in Active Medical Solutions (AMS). We’re excited to support your health journey!
Returning patients: Please update as needed and complete required fields only.
Note: We cannot currently serve patients located in Mississippi. AMS Coaching is available.
GLP-1, Peptides & Compounded Meds
You confirm that you have no history of pancreatitis, gallbladder disease, medullary thyroid cancer, or suicidal ideation.
You are not pregnant/breastfeeding and will use backup contraception if applicable.
You understand that:
- Compounded medications are not FDA-approved.
- There are known and unknown risks, including common and serious side effects.
- Pharmacies are responsible for medication sterility, safety, and strength.
You release AMS and providers from liability related to peptide use.
You will seek emergency care if needed and contact AMS with concerns.
Acknowledgements
You are voluntarily enlisting our services and may cancel at any time after your prescription is completed.
Payment options: $119/month or $149 per transaction.
You consent to receiving care and billing-related text messages.
We require a copy of your Government Issued ID and a current photo before prescribing.
Video/audio calls require scheduling. Group calls are not HIPAA-compliant.
AMS is unaffiliated with any pharmacy and cannot control their fees or processing times.
Prescriptions may not be refundable once sent. Changes may incur fees.
Dosing may vary with compounded medications. Follow your provider’s prescription.
Contact your success team for refills. Refills are not automatic.
Maintain a local primary care physician for in-person care.
AMS does not accept insurance (including Medicare/Medicaid). You are financially responsible.
By continuing, I acknowledge that I have read and agree to the Terms of Service, Privacy Policy, Consumer Disclosures, and Refund Policy.
