For Partnerships Form Extended

Let’s Start with you

Company Name

Website (If available)

Primary Contact Name:

Title/Role

Email

Phone

Step 1:

Tell us about your company

Business Address

Street Address

Street Address Line 2

City

State

ZIP

What Best Describes Your Business?

Step 2:

Describe your Business

What Are You Interested In?

What services or products are you looking to offer through our pharmacy?

Key therapeutic areas (e.g., TRT, GLP-1s, dermatology, etc.):*

Common prescriptions you’ll send our way:*

Expected script volume (daily or weekly estimate):*

Your Coverage & Licensing

What states do you currently serve?*

Do you require multi-state prescription fulfillment?*

Tech & Integration

Can your platform integrate with LifeFile or another API system?*
YesNoNot sure

Step 3:

Integration capabilities

Preferred contact methods:
SlackEmailPhone

Who should we contact for:

Presctiption clarifications:

Patient support issues:

Billing / Invoices

Step 4:

Communication Preferences

Shipping & Fulfillment

What shipping speeds do you need?
GroundTwo-DayNext-Day

White Label & Branding Needs

Do you require customized materials? Select any that apply:*
Prescription labels with your brandingPatient literature sheetsCustom bottlesCustom mailersOther

Why foothills?

No extra fees
No implementation, admin, or clinical fees
Fast Turnarounds
Efficient fulfillment and nationwide shipping
Hands-On Support
A dedicated account manager & responsive customer service

Next steps
Once you complete this form, our team will follow up to schedule a brief onboarding call and begin the process.

Step 5:

New Partner Inquiry