TRUE TEST

Hormone Optimization

Med Room GLP-1 Cost Audit

Pull info from your most recent invoice or pharmacy portal.

Location *

Your Name *

Role / Title

Semaglutide

GLP-1 Agonist

Pharmacy / Supplier

Product Name (as on invoice)

Concentration (mg/ml)

Vial Size (ml)

Price per Vial ($)

Total mg per Vial

—

Cost per mg

—

If you don't carry this drug, type "N/A" in the pharmacy field.

GLP-1 / GIP Dual Agonist

Pharmacy / Supplier

Product Name (as on invoice)

Concentration (mg/ml)

Vial Size (ml)

Price per Vial ($)

Total mg per Vial

—

Cost per mg

—

If you don't carry this drug, type "N/A" in the pharmacy field.

GLP-1 / GIP / Glucagon Triple Agonist

Pharmacy / Supplier

Product Name (as on invoice)

Concentration (mg/ml)

Vial Size (ml)

Price per Vial ($)

Total mg per Vial

—

Cost per mg

—

Supplier

Price per Syringe ($)

Pack Size

Notes / Anything Different About Your Location

Internal use only. Data is sent directly to management.