Getting Started- BodyLabsMD

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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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Patient name* This field is required.
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Patient contact number* This field is required.
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Patient contact email* This field is required.
example@example.com
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Date of BirthWe need this to get your consult started!
Date
Year
Month
Day
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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 TRT & BHRT Solutions for Men and Women
Peptide
Prescription-Strength Skincare
In-Depth Laboratory Assessments
Injectable Vitamins
Sexual Health & Performance Optimization for Men and Women
Customized Nutrition Plans with Grocery Lists
Research Peptides – For Research Purposes Only; Not Affiliated with Medical Providers
Executive Plans
Performance & Cognitive Support: BCAAs, Nootropics, Nutraceuticals
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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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REAL QUICK! Got a question? Send us a message on FACEBOOK belowGet a response within minutes or text us at 580.448.0001
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Choose below to continue.The rest of the form is fast and speeds up the process. We often have same day availability.
I am READY TO START, I'll continue this short form now.
I just want more information about your clinic/pricing/protocol before continuing this form. Please contact me. (Skip Questions to Submit)
I will be in touch when I am ready. You may add me to your email list for non- spam updates. (Skip to Submit)
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How Would You Prefer Treatment? ALL CONSULTS ARE VIA PHONE CALLYou May Change Or Cancel At any Time
Concierge Treatment- Nurse comes to me weekly to administer
Monthly treatment- Ship my treatment to me monthly or as needed
Courier Service-Drop off my medication weekly for me to self administer
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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
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AddressMAILING ADDRESS
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
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Afghanistan
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Algeria
American Samoa
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Anguilla
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The Bahamas
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Cayman Islands
Central African Republic
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eSwatini
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Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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What is your current weight and height?For weightloss patients only
You may skip if not interested in weightloss
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Tell us about your diet in two brief sentences.
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What food choices do you struggle with the most?
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Do you exercise?
Consistently
Never
Sometimes
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What are your goals and an ideal time frame to reach them? You may skip for now if preferred
Explain briefly
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What are is your MAIN goal for taking vitamins and/or Peptides? (Check all that apply)
Energy & Focus
Muscle Recovery
Immunity Boost
General Health Maintenance
Beauty Regimen
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Do you have a history of kidney or liver issues?
Yes
No
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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 peptides (BCAA's) 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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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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Which skin related issues are you suffering from?
Dryness
Stretch marks
Crepey thin skin
Loose Skin
Acne of any type
Under eye bags
Wrinkles
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Which Rx cream are you interested in? (Cost range is $100-$200/month)
AGELESS RENEW- Active Ingredients: Estriol, Sirolimus.Benefits: Reduces wrinkles, restores firmness for smooth, youthful skin.
CASHMERE POLISH- Active Ingredients: GHK-Cu (Copper Peptide).Benefits: Hydrates, repairs, boosts collagen for radiant, dewy skin.
AQUA BIOME- Active Ingredients: Caffeine, GHK-Cu, Niacinamide, Tretinoin.Benefits: Hydrates, firms, smooths uneven skin for a youthful glow.
STELLA- Active Ingredients: Estriol, GHK-Cu, Niacinamide, Tretinoin.Benefits: Reduces early aging signs, balances tone, and elasticity.
VITALITY- Active Ingredients: Estriol, Tretinoin, Alpha Lipoic Acid, Ascorbic Acid, Niacinamide.Benefits: Combats fine lines, smooths oily, acne-prone skin.
CLEAN VITALITY PLUS- Active Ingredients: Estriol, Tretinoin, Alpha Lipoic Acid, Ascorbic Acid, Niacinamide, Finasteride.Benefits: Rejuvenates all skin types, providing long-lasting improvements.
TRENTINOIN ONLY- Promotes collagen production, smooths skin texture, fades dark spots, and treats acne by unclogging pores.
NIACINAMIDE ONLY- Reduces redness, minimizes pores, brightens skin, balances oil, and strengthens the skin barrier.
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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?
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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
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Please list any known allergies (or write “None” if you have no allergies):
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Please list all current medications you are taking (include prescription, over-the-counter, and supplements):
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Medical History: Please list any diagnosed conditions (past or present):
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Do you have any diagosed medical conditions? History of health concerns? communicable diseases, cardiovascular problems, diabetes, asthma etc.?
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What FORM of therapy do you preferLet us know if you can't self inject- we have oral options
Subcutaneous Injections
Intramuscular injections
Oral dosing only- strips, capsules, troches
Creams
I have no preference
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Upload a clear photo of your government-issued ID (front side) to verify your identity.
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
Cancelof
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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.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Book your free discovery call now!Talk with David or Trista before you schedule a provider consultation. We will help you design your personalized plan based on your goals! We will call you at the time below- OR CALL US AFTER YOUR FORM IS COMPLETED! Call or text us at 580-448-0001
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How did you hear about us?Please tell us!
Friend
Facebook
Google
Business card
Hannah Martin Friend/Family
Billboard
Shelby Kropp
Ashley Trowbridge
Mikayla Meadows
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Who referred you? We want to thank them
First and Last Name
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Signed On (Date):* This field is required.
Month
Day
Year
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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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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