For Patients Become a Prescriber

Become a Prescriber

Fill out the form below to begin your prescriber journey. Once submitted, you will receive the Proliv®Rx prescription form by email

    If you’re experiencing any issues with the form, please contact us here

    More Information
    • Depression severity levels:
      Very Severe, Severe, Moderate, Mild, No Depression.
      After completion of a 16-week therapy program.
    • Placebo:
      Explained