
Compete order and health intake approval questions and order below (5-minutes to complete)

✔️ Includes: 3 Boxes of Aquoral Spray & medical review
✔️ 3 boxes shipped one time, 6 canisters total included
✔️ *$24 health intake review is required once every 12 months (Included in price)

Patient Info
Required Health Questions
Prescription Information and Approval:
Because this is a prescription medication a health intake is required for a doctor to review. Please answer brief medical questions and medication information
Gender
Height and Weight
Symptoms. Please select all that apply
Do you have any known allergies to medications or ingredients (such as aspartame or silicon dioxide)?
I understand Aquoral contains aspartame (a sweetener), and should not be used by individuals with PKU (phenylketonuria), a rare genetic disorder.
I do not have PKU and agree to proceed.
Payment and Shipping
⬇️ Confirm your are purchasing 3 months (3 boxes at once)
Terms
Review terms and click agree
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HIPPA compliant secure handling of your personal data
Continued chat support from your clinical care team
Medical evaluation and prescriptions by board-certified physicians