• Practitioner Research Cohort Application

    Each application is reviewed personally by Dr. Lily Woods, PhD. Completion takes about ten minutes. Where there is alignment, the next step is a conversation; where there is not, we will tell you so directly.

  • About You

  • Format: (000) 000-0000.

  • Your Practice

  • Your Role*
  • Years in Practice*

  • Licensure and Prescribing

  • Do you hold independent prescribing authority*
  • If you are a prescriber, do you want to participate in the Factor 14 Labs Prescribing structure?

  • Pathway of Interest

  • Which pathway are you applying for? (select all that apply)*
  • Are you open to receiving BMH-assigned patients matched to your area and licensure?*
  • Approximately how many of your own patients could you bring into the cohort?*

  • Clinical Background

  • Familiarity with functional, precision, or longevity medicine*

  • Research Background

    the cohort conducts process-improvement studies across a range of disease states; acne is one of several. Your research experience and interests help us understand where you would fit.
  • Have you participated in or conducted research studies before?*
  • If Yes, what kind of research? (select all that apply)
  • Approximately how many studies have you been involved in?*
  • What was your role? (select all that apply)
  • Would you want to be credited as a co-author on resulting publications*
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  • Tell us More

  • Acknowledgement

  • By Submitting this form I formally acknowledge that I understand this is an application-only program, that each application is reviewed personally by Dr. Lily Woods, PhD, and that acceptance is not guaranteed

  • What state(s) do you hold prescriptive authority?
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