Medical Information Form

Before we get started, we need some basic health information to ensure your care is safe and personalized

First Name *

Last Name *

Date of birth *

Email *

Phone *

Address

Street Address

City

State

Country

Postal code

What inspired you to explore testosterone therapy?

Have you ever done hormone therapy before?

Do you currently take any supplements or medications?

Do you have any history of prostate issues, heart conditions, or clotting disorders?

How is your energy level during the day?

How is your sleep?

Do you experience any issues with low libido, stamina, or muscle recovery?

Are you currently under the care of another provider for hormone-related issues?

Are you aware that this is a monthly membership and includes testosterone, syringes, and access to peptides?

Do you have any questions or concerns about self-injection?

Would you like more information about the optional supportive supplements?

Would you be interested in learning about peptide stacks once your labs are in?

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

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