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WOMEN'S HRT PRESCRIPTION FORM

For prescribing offices only. Complete the three short steps below to send a compounded Women’s HRT prescription directly to our pharmacists. Typical turnaround is 1–2 business days.

Physician Compounded Prescription Form – Women's HRT
Complete the patient details, click every compound you want to prescribe, then click Next. Only the compounds you select will appear in the next step. Formulation questions? Call 201-997-2010.

Prescriber

Dr. Lisa Cadoo MD
NPI: 1538460498 | DEA: FC3388584

Patient Information

Patient Name

Today's Date

Patient Phone

Patient DOB

Patient Address

Patient Allergies

Compounds to Prescribe

Select every compound for this patient. Each one you tick gets its own section in the next step.

Select compound(s)

Estriol Cream Estradiol Cream Testosterone Cream Biest Cream Biest / P4 Cream Biest / P4 / Testosterone Cream Biest / P4 / Testosterone / DHEA Cream Progesterone Capsules DHEA Capsules BHRT Troche T3 / T4 Capsules LDN Capsules LDN Titration Pack

Complete each section below. Typical women's strengths and combinations; testosterone below 25 mg. Dispensing devices included with creams.

Estriol Cream

Vaginal cream

Estriol Cream – Strength (mg/g)

Estriol Cream – Quantity (grams)

Estriol Cream – Other quantity

Estriol Cream – SIG (Directions)

Estriol Cream – Custom SIG

Estradiol Cream

Vaginal cream

Estradiol Cream – Strength (mg/g)

Estradiol Cream – Quantity (grams)

Estradiol Cream – Other quantity

Estradiol Cream – SIG (Directions)

Estradiol Cream – Custom SIG

Testosterone Cream

Vaginal cream · testosterone below 25 mg

Testosterone Cream – Strength

0.25 mg/g 0.5 mg/g 1 mg/g Custom

Testosterone Cream – Custom strength (mg/g)

Testosterone Cream – Quantity (grams)

Testosterone Cream – Other quantity

Testosterone Cream – SIG (Directions)

Testosterone Cream – Custom SIG

Biest Cream

Combination cream

Biest Cream – Biest ratio (e.g. 80/20)

Biest Cream – Biest strength (mg/g)

Biest Cream – Quantity (grams)

Biest Cream – Other quantity

Biest Cream – SIG (Directions)

Biest Cream – Custom SIG

Biest / P4 Cream

Combination cream

Biest / P4 Cream – Biest ratio (e.g. 80/20)

Biest / P4 Cream – Biest strength (mg/g)

Biest / P4 Cream – Progesterone (P4) strength (mg/g)

Biest / P4 Cream – Quantity (grams)

Biest / P4 Cream – Other quantity

Biest / P4 Cream – SIG (Directions)

Biest / P4 Cream – Custom SIG

Biest / P4 / Testosterone Cream

Combination cream · testosterone below 25 mg

Biest / P4 / Testosterone Cream – Biest ratio (e.g. 80/20)

Biest / P4 / Testosterone Cream – Biest strength (mg/g)

Biest / P4 / Testosterone Cream – Progesterone (P4) strength (mg/g)

Biest / P4 / Testosterone Cream – Testosterone strength (mg/g)

Biest / P4 / Testosterone Cream – Quantity (grams)

Biest / P4 / Testosterone Cream – Other quantity

Biest / P4 / Testosterone Cream – SIG (Directions)

Biest / P4 / Testosterone Cream – Custom SIG

Biest / P4 / Testosterone / DHEA Cream

Combination cream · testosterone below 25 mg

Biest / P4 / Testosterone / DHEA Cream – Biest ratio (e.g. 80/20)

Biest / P4 / Testosterone / DHEA Cream – Biest strength (mg/g)

Biest / P4 / Testosterone / DHEA Cream – Progesterone (P4) strength (mg/g)

Biest / P4 / Testosterone / DHEA Cream – Testosterone strength (mg/g)

Biest / P4 / Testosterone / DHEA Cream – DHEA strength (mg/g)

Biest / P4 / Testosterone / DHEA Cream – Quantity (grams)

Biest / P4 / Testosterone / DHEA Cream – Other quantity

Biest / P4 / Testosterone / DHEA Cream – SIG (Directions)

Biest / P4 / Testosterone / DHEA Cream – Custom SIG

Progesterone Capsules

BHRT capsule · #30 or #90 · sustained-release available

Progesterone Capsules – Strength per capsule (mg)

Progesterone Capsules – Capsule type

Progesterone Capsules – Quantity (capsules)

Progesterone Capsules – Other quantity

Progesterone Capsules – SIG (Directions)

Progesterone Capsules – Custom SIG

DHEA Capsules

BHRT capsule · #30 or #90 · sustained-release available

DHEA Capsules – Strength per capsule (mg)

DHEA Capsules – Capsule type

DHEA Capsules – Quantity (capsules)

DHEA Capsules – Other quantity

DHEA Capsules – SIG (Directions)

DHEA Capsules – Custom SIG

BHRT Troche

All typical women's strengths & combinations · custom combinations available · testosterone below 25 mg

BHRT Troche – Ingredient(s)

Biest Estriol Estradiol Progesterone Testosterone DHEA

BHRT Troche – Strength per troche (mg) – list each ingredient

BHRT Troche – Quantity (troches)

BHRT Troche – Other quantity

BHRT Troche – SIG (Directions)

T3 / T4 Capsules

Thyroid · all strengths & combinations

T3 / T4 Capsules – Strength & combination (mcg)

T3 / T4 Capsules – Quantity (capsules)

T3 / T4 Capsules – Other quantity

T3 / T4 Capsules – SIG (Directions)

LDN Capsules

Low-dose naltrexone · 0.1–4.5 mg (doses above 4.5 mg available)

LDN Capsules – Strength (mg)

LDN Capsules – Quantity (capsules)

LDN Capsules – Other quantity

LDN Capsules – SIG (Directions)

LDN Titration Pack

Each pack includes 15 capsules of each strength for a stepwise titration

LDN Titration Pack – Pack(s)

Pack A: 0.5 mg + 1 mg Pack B: 1.5 mg + 2 mg Pack C: 2.5 mg + 3 mg Pack D: 3.5 mg + 4 mg

LDN Titration Pack – Titration SIG (Directions)

LDN Titration Pack – Doses above 4.5 mg / other request

Prescription Information

Refills #

Refill authorization

As needed for 1 year

Additional notes for the pharmacist

Prescriber Signature (type full name)

I am the prescriber (or the prescriber's authorized agent) and I authorize this prescription as written. *

Submitted directly to HB Pharmacy. Prefer fax? Send to 1-201-997-8488 or email pharmacist@hbpharmacy.com.