Veteran Owned and Operated

Tirzepatide/Semaglutide Pricing

Initial visit consultation fee: $50.00

Tirzepatide B6 / B12 (1 month supply)

2.5mg-1mg / 2 ml (10 mg)

$260.00

5 mg-1 mg / 2 ml (20 mg)

$325.00

7.5mg-1mg / 2ml (30 mg)

$385.00

10mg-1mg / 2 ml (40 mg)

$445.00

12.5mg-1mg / 2ml (50 mg)

$505.00

15mg-1mg / 2ml (60 mg)

$565.00

Semaglutide B6 / B12 (1 month supply)

0.25 mg / 0.5 mg (1mg)

$225.00

0.5 mg / 0.5 mg (2 mg)

$260.00

1 mg / 1 mg (4 mg)

$305.00

1.7 mg / 1 mg (6.8 mg)

$375.00

2 mg / 1 mg (8 mg)

$395.00

2.5 mg / 1 mg (10 mg)

$410.00

NHHC logo

Sheila L. Uridil, MSN, APRN, AGACNP-BC, ANP-BC
Joseph E. Uridil IV, MSN, APRN, AGACNP-BC
NeighborhoodHealthcareJ.S@gmail.com

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Patient Medical History

Purpose: To evaluate patient eligibility, safety, and appropriateness for Tirzepatide/Semaglutide therapy.

1. Chief Complaint / Reason for Visit*
<strong>1. Chief Complaint / Reason for Visit</strong>
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3. Past Medical History (Check all that apply)*
<strong>3. Past Medical History</strong> (Check all that apply)
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6. Allergies*
<strong>6. Allergies</strong>
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7. Family History*
<strong>7. Family History</strong>
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8. Social History

Tobacco*
<strong>Tobacco</strong>
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Alcohol*
<strong>Alcohol</strong>
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Recreational Drugs*
<strong>Recreational Drugs</strong>
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9. Review of Systems (check any that apply)*
<strong>9. Review of Systems</strong> (check any that apply)
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