• Before we prescribe you, our medical team has a few quick questions to make sure this is a good fit for you.

  • Format: (000) 000-0000.
  • Are you male or female?*

  • Before we prescribe you, our medical team has a few quick questions to make sure this is a good fit for you.

  • Are you pregnant and/or breastfeeding?*
  • Are you currently using any birth control products?*
  • Are you currently taking (or have you stopped taking within the last 90 days) any menopausal hormone treatment? (For example: birth control pills, compounded hormones or creams, sprays, gels, or hormonal pellets)*
  • Have you had a hysterectomy?*
  • Which of the following best describes your menstrual cycle in the past 12 months?*
  • Please indicate if you have or have had any of the following conditions:*

  • Great! Thanks for that information.

    Now, tell us a little about your symptoms.

  • Medical History

    Next, a few questions about your medical history.
  • When was your last mammogram?*
  • What were the results of your last mammogram?*
  • Are you currently taking any Selective Serotonin Reuptake Inhibitors, or SSRIs? (For example: Paxil, Effexor, Lexapro, Zoloft, or Prozac)*
  • Are you currently taking any other medications?*
  • Are you currently using blood thinners and/or nitrates?*
  • Do you have allergies? This includes all allergies, intolerances, and reactions to foods or previous medications (i.e. peanut allergies)*

  • Personal Information

    Finally, a few last questions about you personally.
  • What is your date of birth?*
     - -

  • How tall are you?

    Please list your height in feet and inches below:

  • Meet with a Provider

    Please share your contact details and schedule a meeting with a provider to discuss your options.
  • Pick an available time to meet with a provider:*

  • Thank you for you interest!

    We are working to provide prescriptions in more states but haven’t made it to yours yet.

    We do offer some great options that don’t require a prescription and can provide significant benefits.

  • Thank you for you interest!

    Due to your unique needs we recommend you contact a local provider for guidance on prescriptions.

    We do offer some great options that don’t require a prescription and can provide significant benefits.

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