Where did you hear about us? *

• Search engine
• Instagram/Socials
• Google/Apple maps
• Physician referral
• American Peptide Society
• Profusions client
• Friend/family
• Local gym

What are you interested in? Prices starting at *

• TRT - $99
• Tox or Fillers
• HCG + TRT - $179
• HCG only - $199
• Peptides - $220
• Weight Loss - $399
• Other

What are your goals? *

• Improve sex life
• Increase energy & strength
• Perform better & competing
• Lose/gain weight or change body composition
• Decrease recovery times
• Improve sleep & wake up rested

Select all that apply

Personal goal(s).

Are you currently on TRT, HGH or Peptide therapy?

• Peptides
• TRT
• HGH
• HRT
• none

Select all that apply

Do you have your own labs? (<60 days)

• Yes
• No

What method of communication do you prefer?

• Phone calls
• Texts
• Email

What is your full name? *

What is you email? *

Phone number we can reach you on.

Would you like a free RN consult before initiating therapy to answer question and provide further resources?

• Yes
• No

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