New Account Packet - Hallandale Pharmacy 2026

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  1. Click ‘Get Form’ to open the New Account Packet in our editor.
  2. Begin with the Doctor Patient Relationship Letter. Ensure you provide your name, signature, and date to confirm the establishment of a valid doctor-patient relationship.
  3. Next, complete the HGH Profile Agreement. Fill in your clinic name, contact name, and doctor's name. Answer all questions regarding patient demographics and ensure compliance with legal indications for prescribing HGH.
  4. Proceed to the Credit Card Authorization Form. Clearly print your name as it appears on the card, billing address, phone number, and email. Select your card type and enter your card number along with the expiration date and CVV code.
  5. Review all sections for accuracy before signing each form where required. Make sure to attach copies of your most recent State License and DEA License.
  6. Once completed, save your document and utilize our platform's features to fax or email it directly to Hallandale Compounding Pharmacy.

Start filling out your New Account Packet today for free using our platform!

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Hallandale Pharmacy is BBB Accredited. This business has committed to upholding the BBB Standards for Trust.
IMPORTANT SEMAGLUTIDE UPDATE Due to recent FDA changes, Hallandale Pharmacy will discontinue production of Semaglutide. Starting April 23, 2025, Polk Concierge Medical will transition to Strive Pharmacy, a trusted Tampa-based compounding pharmacy already used by many of our patients.
As your trusted compounding pharmacy partner, we provide the highest quality custom medications to help others feel their best. Since our establishment in 2004, the growing demand for customized medications has propelled us to deliver an unparalleled pharmacy experience.
Verify that the pharmacy complies with applicable USP compounding standards. Ask if the pharmacy only sources their active pharmaceutical ingredients from FDA-registered facilities (as required by federal law). Ask if periodic testing of compounded medications is performed by a third-party lab.
At Hallandale Pharmacy, we hold accreditation from PCAB (Pharmacy Compounding Accreditation Board). This accreditation demonstrates our commitment to upholding industry standards in pharmaceutical compounding.