Fast Contact Form

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What are we working on first?* This field is required.
Metabolic (weight)
Hormones and testosterone
Energy and recovery
Skin and beauty
Advanced ODS strips
Not sure yet, tell me more
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Adults 18+ · Operated by Be Well Wellness Services LLC · (580) 448-0001 · BodyLabsMD@gmail.com
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Name* This field is required.
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Contact Number* This field is required.
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Email* This field is required.
example@example.com
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Date of Birth* This field is required.We need this to get your consult started!
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AddressCity and State are needed
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Best way to reach you* This field is required.
Text
Call
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Best time of day
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BE WELL BODY LABS FAQs: Select each box you would like detailed info for. Who we are, what we do, who we serve
WHO IS BODY LABS?
WHAT DO WE OFFER?
HOW DOES IT WORK?
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What is your gender?* This field is required.
Please Select
Female
Male
Transgender
Non-binary
Prefer not to answer
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Patient contact email* This field is required.
example@example.com
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If using your own labs, please upload any recent lab results you would like us to review.
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If applicable, please list which labs you have had tested (e.g., vitamin D, B12, ferritin, magnesium, thyroid, A1c).
15
Do you consent to communication from our Care Coordinators?YOUR INFORMATION IS PROTECTED AND FOR OFFICE USE ONLY
Use "ANY" form of contact
I prefer "CALLS" only
I prefer "TEXT" only
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By submitting this form, you agree that BodyLabsMD may contact you by call or text at the number provided about your inquiry, appointments and care, including by automated means. Consent is not a condition of purchase. Message frequency varies. Message and data rates may apply. Reply STOP to opt out or HELP for help. Your information is handled under our Privacy Policy: https://www.bodylabsmd.com/privacy-policy/
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Let’s Get You StartedTakes less than 2 minutes. Same-day availability in most cases.
Schedule My Consultation Now! Continue with a quick intake to receive your personalized protocol.
I Have a Few Questions First! Talk with our team about pricing, protocols, and eligibility.
Not Ready Yet. Send me occasional updates and offers.
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I understand that my vitamin recommendations will be based on the information provided above and that lab testing or add-ons may involve additional costs.* This field is required.
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How Would You Prefer Treatment? Consults are virtualMedical providers are Local
Concierge Treatment- Nurse comes to me weekly to administer
Monthly treatment- Ship my treatment to me monthly or as needed
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Date of Birth
Month
Day
Year
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Gender
Please Select
Please Select
Male
Female
Transitioning
Prefer not to say
22
Do you have a history of kidney or liver issues?
Yes
No
23
Which symptoms would you like to improve?You may skip for now if preferred
Please Select
Overall drive
Symptoms of depression
Difficulty sleeping
Hot flashes
Loss of concentration, sociability, and activity
Loss of interest in sex
Decreased desire and ability to exercise
Decreased energy and endurance
Decreased sense of well-being
Decreasing memory
Decreasing muscle strength
Sagging, loose or thin skin
Sore Muscles, joint pain(s)
Weight loss - Unexplained
Reduced erectile function
Pale Skin, We can tan you with Melanotan Peptide!
Feeling very tired all the time (fatigue)
Obesity
Stomach pain
Irritable bowels
Intense sugar cravings
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Are you interested in our services for any of the life improving therapies listed below?Peptides are safe, effective therapies that improve all aspects of physical and cognitive health and quality of life
Please Select
Growth Hormone Stimulator
Hormone Enhancement
Cardiovascular health
Metabolic boost
Age Rewind
Weightloss Peptides
Complete Pro Performance Peptide Blend
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What are is your MAIN goal? (Check all that apply)
Energy & Focus
Muscle Recovery
Immunity Boost
General Health Maintenance
Beauty Regimen
Improve EVERYTHING
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Are you currently on hormone replacement therapy?Any type in any other location?
YESNO
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Do you experience any of the symptoms?
Fatigue or low energy
Mood swings, irritability, or depression
Reduced libido or sexual dysfunction
Hot flashes or night sweats
Dry skin, thinning hair, or brittle nails
Decreased muscle mass or strength
Memory issues or brain fog
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Are you struggling with thyroid issues?
Yes
No
No idea
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Would you like to recommend anyone for a free consultation? We offer discounts for both of you.This can be a partner, friend or family member as well.
YESNO
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Have you had your labs done in the past 3 months?This is only needed for hormone prescribing
Yes, I can send in my lab results
No, but I am interested in checking my levels
Only here for the weightloss with no labs
Curious about pricing and type of testing offered
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Do you need treatment for any of the following?
Intimacy/Bonding/Desire
Less firm erections
Vaginal dryness
Testicular shrinkage
Lack of sexual desire
Lack of sex drive
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What form of lab testing do you prefer?We mail at home saliva tests or order lab blood draws - Statewide. IHC, Quest, or Lab Corp.
Please Select
Blood draw as a walk in to Quest or Labcorp $150+
Concierge Blood draw from home/work? ($75 nurse travel fee state wide.) $200+ for Hormones
Hormone levels are all we require. As an added benefit, we have full lab testing capabilities at clinic cost available for all bodily systems.
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Choose your preferred form of payment
Please Select
Invoiced Cash/Self pay (discounted clinic pricing)
Monthly Auto PAy
FSA/HSA account
CARE credit
Affirm or Financing
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What monthly budget would you like us to keep in mind when planning your treatment?
35
Please list all current medications you are taking (include prescription, over-the-counter, and supplements):
36
Do you consent to telehealth treatment and virtual services?* This field is required.All medical consults and reviews are over the phone with our medical providers.
Yes
No
37
Please list any known allergies (or write “None” if you have no allergies):
38
Medical History: Please list any diagnosed conditions (past or present):
39
Do you have any diagosed medical conditions? History of health concerns? communicable diseases, cardiovascular problems, diabetes, asthma etc.?
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Do you have labs to share with us from your PCP?This will help us determine the best treatment for you without running our own labs.
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Select files to upload
Max. file size: 10.6MB
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How did you hear about us?Please tell us!
Friend
Event
Facebook
Google
Business card
Billboard
Ashley Trowbridge
Tanner Anderson
Chanol Barnum
Mikayla Meadows
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Who referred you? * This field is required.We want to thank them
First and Last Name
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May we contact the person who referred you to let them know you signed up and thank them with a $50 gift card?No obligation!
YESNO
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Upload a clear photo of your government-issued ID (front side) to verify your identity.We have to have this to do a virtual consultation. You can also text it to us at 580-448-0001
Drag and drop files here
Select files to upload
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Upload Before Picture (optional) We will use this to compare your progress later!This can be your face only, body with clothes, or in swim wear, or with out clothes. However you feel comfortable
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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Patient Signature – I certify that the information provided above is true, complete, and accurate to the best of my knowledge.* This field is required.
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Signed On (Date):* This field is required.
Month
Day
Year
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What Telemedicine services interest you? *All treatments are shipped to your doorYou may choose multiple options.
Transformative Medical Weight Loss Programs
Hormone Balance & Optimization: Tailored for Men and Women
Prescription Skincare
Lab Orders
Injectable Vitamins
Sexual Health & Performance Optimization for Men and Women
Customized Nutrition Plans with Grocery Lists
Lab Based Vitamin Stacks
Executive Plans (we build for you)
Cognitive Support: Nootropics, Nutraceuticals
Personal Training (in person or Virtual)
ADHD Therapy
Corporate Wellness or Concierge
Luxury Apartment Wellness
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Should be Empty:

Overall drive
Symptoms of depression
Difficulty sleeping
Hot flashes
Loss of concentration, sociability, and activity
Loss of interest in sex
Decreased desire and ability to exercise
Decreased energy and endurance
Decreased sense of well-being
Decreasing memory
Decreasing muscle strength
Sagging, loose or thin skin
Sore Muscles, joint pain(s)
Weight loss - Unexplained
Reduced erectile function
Pale Skin, We can tan you with Melanotan Peptide!
Feeling very tired all the time (fatigue)
Obesity
Stomach pain
Irritable bowels
Intense sugar cravings