Partnership Inquiries

CONTACT INFORMATION

Full Name*

Email*

Phone*

Website*

ORGANIZATION INFORMATION

Organization Name*

Primary Location*

How many states do you plan to serve?*
All 50 States1-56-1516-3031+

Company Size*
1-56-2021-5051-200200+

How would you describe your organization?
Startup / Early-stageGrowing / ScalingEstablished BusinessEnterprise

How did you hear about Curexa?*

OPERATIONAL & PARTNERSHIP DETAILS

Current Monthly Prescription Volume*
Pre-launch1-500501-1,0001,001-5,0005,001-10,00010,001+

What is your primary source of patient volume?*
Existing patient baseTelehealth/provider networkPaid marketingOrganic (social/referrals)Other

If "Other", please specify:

Which telehealth provider network are you partnering with*

Which telehealth tech platform(s) are you using?*

Are you LegitScript certified?*
YesNo

What types of products do you plan to offer?*
Compounded productsCommercial (retail) productsBoth (compound + retail)

Do you plan to include OTC products or supplements in your offering?*
YesNoMaybe

Which treatment areas are you interested in partnering on?*
Anti-agingDermatologyDigestive HealthED (Erectile Dysfunction)Hair LossHRT (Hormone Replacement Therapy)LongevityMen’s HealthPain ManagementPeptidesSleepWellnessWeight LossWomen’s HealthOther

If "Other", please specify:

If you have specific compounded formulations in mind, please list them below.*

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