Membership & Billing Acknowledgment
Review how your membership changes with starting testosterone therapy, then confirm your billing acknowledgment and e-sign.
Testosterone Therapy Patient Guide
I confirm that I have read the Testosterone Therapy Patient Guide and watched the video included in it.
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I confirm that I have read the Testosterone Therapy Patient Guide and watched the video included in it.
Membership & Billing — What to Expect
Joined before June 2025 (Legacy, $85/month):
No change. Testosterone is included in your current plan.
Joined June 2025 to July 17, 2026 ($70/month):
Your membership will be automatically upgraded to Tier 2 ($95/month), if not already.
Joined after June 2026:
If you are already receiving estrogen and/or progesterone through The Menopause Clinic, a $20/month testosterone rider will be added to your membership. If testosterone is the first hormone you are starting with us, there is no additional testosterone add-on.
I acknowledge that whichever of the above applies to my account will take effect automatically, and my card on file will be charged accordingly beginning 24 hours before my scheduled in-person visit.
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I acknowledge that whichever of the above applies to my account will take effect automatically, and my card on file will be charged accordingly beginning 24 hours before my scheduled in-person visit.
Full Name
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First Name
Last Name
Date of Birth (MM-DD-YYYY)
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
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Date Signed
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Acknowledge & Sign
Acknowledge & Sign
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