• Patient Pay Direct

    Send the signed order and patient details. The patient pays BellaVita directly, and we ship within 48 hours of payment.

  • Ordering provider

  • Patient

  • Patient Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Write directions in syringe units AND mL (for example: Inject 25 units (0.25 mL) SC weekly for 4 weeks). Orders confirmed and paid by 12:00 PM PT are processed the same day. Cold-chain products ship with ice packs.

  • Prescription

  • Products ordered*

  • Recommended dose: AICAR 50mg Vial
    Inject 0.2ml SC; 5 days on / 2 off

  • Recommended dose: AOD 9604 10mg Vial
    Inject 0.25ml SC

  • Recommended dose: ARA-290 20mg Vial
    Dose as prescribed

  • Recommended dose: Bacteriostatic Water 30mL Vial
    Diluent for reconstituting vials

  • Recommended dose: BPC-157 10mg Vial
    Inject 0.15ml SC

  • Recommended dose: BPC-157 / TB4 10mg / 10mg Vial
    Dose as prescribed

  • Recommended dose: Cagrilintide 8.4mg Vial
    Weekly 12.5 units x4 wks then 25 then 50 units

  • Recommended dose: Cagrilintide / Semaglutide 8.4mg / 7mg Vial
    Weekly 15 units x4 wks then 30 then 65 units

  • Recommended dose: Cerebrolysin 2000mg Vial
    Inject 0.2–0.25ml SC daily; Mon–Fri

  • Recommended dose: CJC-1295 + Ipamorelin 5mg / 5mg Vial
    Inject 0.10ml SC at bedtime; empty stomach

  • Recommended dose: CJC-1295 + Ipamorelin 10mg / 10mg Vial
    Inject 0.10ml SC at bedtime; empty stomach

  • Recommended dose: CJC 1295 + Ipamorelin 15mg Vial Ipamorelin only
    Inject 0.10ml SC at bedtime; empty stomach

  • Recommended dose: DSIP 5mg Vial
    Inject 0.1ml SC daily at bedtime

  • Recommended dose: Epitalon 25mg Vial
    Inject 0.1ml SC daily at bedtime

  • Recommended dose: Epitalon 50mg Vial
    Inject 0.1ml SC daily at bedtime

  • Recommended dose: GHK-CU 25mg Vial
    Inject 0.2ml SC daily

  • Recommended dose: GHK-CU 50mg Vial
    Inject 0.2ml SC daily

  • Recommended dose: Hexarelin 5mg Vial
    Inject 0.10ml SC once daily

  • Recommended dose: Humanin 10mg Vial
    Dose as prescribed

  • Recommended dose: IGF-1 LR3 1mg Vial
    Inject 0.1ml SC daily for 30 days

  • Recommended dose: IRGD 12.5mg Vial
    Dose as prescribed

  • Recommended dose: Kisspeptin 10mg Vial
    Inject 0.10ml SC once daily

  • Recommended dose: KPV 10mg / 10mg Vial
    Dose as prescribed

  • Recommended dose: KPV / BPC-157 10 mg Vial
    Dose as prescribed

  • Recommended dose: LL-37 10mg Vial
    Inject 0.10ml once daily

  • Recommended dose: Melanotan II 10mg Vial
    Inject 0.15ml daily 1–2 wks then 0.25ml twice weekly

  • Recommended dose: MOTS-C 20mg Vial
    Inject 0.5ml SC twice a week

  • Recommended dose: NAD+ 1000mg Vial
    Inject 0.2ml daily

  • Recommended dose: Oxytocin 10mg Vial
    Dose as prescribed

  • Recommended dose: Oxytocin / PT-141 / VIP Nasal Spray
    Dose as prescribed

  • Recommended dose: PE-22-28 10mg Vial
    Inject 0.10–0.20ml SC; 5 days a week

  • Recommended dose: Pentosan 500mg Vial
    Inject 0.10–0.20ml SC once daily

  • Recommended dose: Pinealon Acetate 20mg Vial
    Inject 0.10–0.20ml SC once daily

  • Recommended dose: PNC-27 25mg Vial
    Inject 0.10ml SC once daily

  • Recommended dose: PT-141 20mg Vial
    Inject 0.2ml 30 min before activity (max 2x weekly)

  • Recommended dose: GLP-3 (Retatrutide) 14mg Vial
    Weekly 12.5 units x4 wks then 25 then 50 units

  • Recommended dose: GLP-3 (Retatrutide) 28mg Vial
    Weekly 12.5 units x4 wks then 25 then 50 units

  • Recommended dose: Selank 12.5mg Vial
    Inject 0.1ml SC every morning

  • Recommended dose: GLP-1 (Semaglutide) 7mg Vial
    Weekly 12.5 units x4 wks then 25 then 50 units

  • Recommended dose: GLP-1 (Semaglutide) 12mg Vial
    Weekly 12.5 units x4 wks then 25 then 50 units

  • Recommended dose: GLP-1 (Semaglutide) 24mg Vial
    Weekly 12.5 units x4 wks then 25 then 50 units

  • Recommended dose: GLP-1 (Semaglutide) / BPC-157 7mg / 2mg Vial
    Weekly 15 units x4 wks then 30 then 65 units

  • Recommended dose: Semax-Selank Combo 12.5mg Vial
    Dose as prescribed

  • Recommended dose: Sermorelin 15mg Vial
    Inject 0.10–0.20ml SC daily

  • Recommended dose: SS-31 25mg Vial
    Inject 0.20ml SC daily

  • Recommended dose: Tesamorelin 2.5mg Vial
    Inject 0.20ml daily or 0.10ml twice daily SC

  • Recommended dose: Tesamorelin 5mg Vial
    Inject 0.20ml daily or 0.10ml twice daily SC

  • Recommended dose: Tesamorelin 10mg Vial
    Inject 0.20ml daily or 0.10ml twice daily SC

  • Recommended dose: Thymosin Alpha-1 10mg Vial
    Inject 0.15ml SC once daily

  • Recommended dose: Thymosin Alpha-1 15mg Vial
    Inject 0.15ml SC once daily

  • Recommended dose: Thymosin Beta-4 10mg Vial
    Inject 0.25ml SC

  • Recommended dose: Thymosin Beta-4 15mg Vial
    Inject 0.25ml SC

  • Recommended dose: GLP-2 (Tirzepatide) 10mg Vial
    Weekly 2.5mg x4 wks then 5mg then 10mg

  • Recommended dose: GLP-2 (Tirzepatide) 20mg Vial
    Weekly 2.5mg x4 wks then 5mg then 10mg

  • Recommended dose: GLP-2 (Tirzepatide) 40mg Vial
    Weekly 2.5mg x4 wks then 5mg then 10mg

  • Recommended dose: GLP-2 (Tirzepatide) 60mg Vial
    Weekly 2.5mg x4 wks then 5mg then 10mg

  • Recommended dose: VIP 10mg Vial
    Dose as prescribed

  • Recommended dose: 5-Amino-1MQ 50mg (30 capsules)
    Oral; one capsule daily

  • Recommended dose: Amlexanox 40mg (60 capsules)
    Oral; one capsule daily or as prescribed

  • Recommended dose: BPC-157 500mcg (60 capsules)
    Oral; one capsule daily

  • Recommended dose: Dihexa 2mg (30 capsules)
    Oral; one capsule daily

  • Recommended dose: Dihexa 5mg (30 capsules)
    Oral; one capsule daily

  • Recommended dose: Dihexa 10mg (30 capsules)
    Oral; one capsule daily

  • Recommended dose: Fenbendazole 300mg (30 capsules)
    Oral; 1 capsule; 3 days on / 4 off

  • Recommended dose: KPV 500mcg (30 capsules)
    Oral; one capsule daily

  • Recommended dose: Larazotide 500mcg (60 capsules)
    Oral; one capsule twice daily

  • Recommended dose: MK-677 10mg (capsules)
    Oral; one capsule daily before bedtime

  • Recommended dose: MK-677 25mg (capsules)
    Oral; one capsule daily before bedtime

  • Recommended dose: NAD+ 100mg (30 capsules)
    Oral; one capsule daily

  • Recommended dose: Orforglipron 12mg (30 capsules)
    Dose as prescribed

  • Recommended dose: Rapamycin 2.5mg (30 capsules)
    Oral; 5mg weekly

  • Recommended dose: Rapamycin 5mg (30 capsules)
    Oral; 5mg weekly

  • Recommended dose: GLP-1 (Semaglutide) 7mg (30 capsules)
    Dose as prescribed

  • Recommended dose: SLU-PP-332 500mcg (60 capsules)
    Oral; two capsules daily

  • Recommended dose: Tesofensine 1mg (30 capsules)
    Oral; one capsule daily

  • Recommended dose: Tesofensine 0.5mg (30 capsules)
    Oral; one capsule daily

  • Recommended dose: BPC-157 / GHK-CU Topical Cream 30g / 1oz Topical cream
    Topical; apply as needed

  • Recommended dose: GHK-CU / BPC-157 Hair Foam 50ml / 1.7oz Hair foam
    Apply foam to clean; damp hair

  • Recommended dose: GHK-CU Face Serum 30ml / 1.0 oz Face serum
    Apply as directed

  • Recommended dose: PT-141 20mg Nasal Spray
    Nasal; 2 sprays each nostril (max 2x weekly)

  • Recommended dose: Selank 12.5mg Nasal Spray
    Nasal; 1–2 sprays once daily

  • Recommended dose: Semax 12.5mg Nasal Spray
    Nasal; 1–2 sprays once daily

  • Recommended dose: Semax 12.5mg Vial
    Inject 0.1ml SC every morning

  • Recommended dose: Semax-Selank Combo 12.5mg Nasal Spray
    Nasal; 1–2 sprays once daily

  • Recommended dose: Topical Rapamycin 30g / 1oz Cream
    Apply as directed

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  • 1. Rx verification

  • Product matches catalog? (staff)

  • 2. Patient contact

  • Contact date (staff)
     - -
    2 digit month, 2 digit day, 4 digit year

  • 4. Fulfillment & shipping

  • Package checklist (staff)
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