Bulk Order Request 
Questions: 
- Text 602-607-5094
 - Email us at RX@onthegopharma.com
- Call 602-607-5094. Leave us a message and we will call you back

3 Easy Steps:

1. Request medications below
2. Ask any questions to our providers or pharmacists. 
2. Pay via link in your email/text message once order approved (within 24 business hours)
3. Direct Delivery - Meds Delivered directly to you


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Email *
What is your FIRST and LAST name? *
What is your Date of Birth? (Payground, our payment processor, is going to ask for your Date of Birth to make payment )
 *
MM
/
DD
/
YYYY
Phone number *
Shipping Address: What is your house number and street name? IE. 123 W Main Street APT B *
Shipping Address: City *
Shipping Address: State     *
Shipping Address: Zip Code *
Do you have any allergies? If NO, leave blank
Do you have any health conditions? If NO, leave blank
What is your Primary Care Doctors Name (PCP)?  *
When was your last Doctor's Visit to your PCP?  *
Antibiotic Prevention Kit -  6 Antibiotics, 3 fluconazole tablets & 30 anti-nausea tablets

1.) Amoxicillin-Clavulanate (generic Augmentin) Broad Spectrum Antibiotic 875/125 mg - 20 tablets in manufacturer sealed bottle 

2.)Azithromycin (generic Z-Pak) 250 mg - 12 tablets ( 2 - generic Zpaks)

3.)  Ciprofloxacin 500 mg tablets - 30 tablets

4.)  Doxycycline Hyclate 100 mg - 50 capsules or tablets

5.) Metronidazole (generic Flagyl) 500 mg - 30 tablets

6.) Trimethoprim-Sulfamethoxazole (generic Bactrim) 800/160 mg - 30  tablets

Anti-Fungal:
-Fluconazole (generic Diflucan) 150 mg - 3 tablets

Anti-Nausea:
· Ondansetron (generic Zofran) 4mg - 30 tablets 

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 *
Do you need to request antibiotics?
 *
Required
Do you need Hydroxychloroquine [HCQ] 200 mg tablets? *
Do you need  Tamiflu (Oseltamivir) 75 mg capsules for the FLU VIRUS? 5 day treatment $34 Each Expiration June 2026 Manufacturer Sealed Package 
 *
Yes; I need a Medrol [Methylprednisolone] Dose Pak $24 each - Manufacturer Sealed Package  *
Required
Do you want to request steroids to help with breathing or pain? 
 *
Do you need nebulizer MEDICATION for respiratory symptoms? ** This medication requires a nebulizer for use**
Available Here *
Do you need an ALBUTEROL INHALER Available Here
 *
Do you need medication for cough?
 *
Do you need medications for Nausea or vomiting? *
Do you need allergy meds? *
Required
Do you need Vitamins? Vitamins
 *
Required
Fluconazole 150 tablet to treat YEAST infections
Available Here *
CofixRX (Povidone Iodine with Vitamin D3) Nasal & Throat Spray Available Here *
Would you like to request a year's supply of your current maintenance medications OR any medication not listed above? (For example, blood pressure, thyroid, viagra, etc). If No, leave blank
Do you need Ibuprofen 800 mg tablets Available Here
 *
Would you like to refer a customer? if NO, leave blank. YES; Please provide first name, last name, email and/or phone number
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