TELEHEALTH REQUEST FORM
Select a consult type and complete the questionnaire.
Important Appointment Information
These appointments are subject to a professional service fee that must be paid in full prior to confirmation of your appointment date and time.
Please select a consult type below, then complete the questionnaire before submitting your request.
- Q&A Consult — $125
- Nutritional Consult (First Time) — $500
- Nutritional Consult (Follow-up) — $150
- Prescription Peptide Consult — $100
- Hormone Therapy Consult — $100
*Submission of this form does not guarantee an appointment. Your selected time slot will be secured only after payment has been successfully processed at checkout. Confirmation details will be sent via email.
*Fees are non-refundable once an appointment time has been confirmed. Cancellations must be made at least 24 hours in advance. Failure to attend a scheduled appointment or late cancellation may result in forfeiture of the consultation fee and may be subject to an additional administrative charge.
*For Prescription Peptide Consult and Hormone Therapy Consult, the consult fee will be applied as a credit toward the purchase of prescribed peptides and/or hormone therapy (when applicable).