Clone of NAD+ Intake & Eligibility Screening

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Physician Led. Nurse Delivered.

Estimated Completion Time: Under 2 Minutes

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Full Legal Name* This field is required.

First Name

Middle Name

Last Name

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Primary email address* This field is required.

example@example.com

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Do any of the following apply to you?* This field is required.

Under the age of 18

Currently pregnant or breastfeeding

Active cancer diagnosis

None of the above

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Thank you for your interest. At this time, we are unable to process orders for individuals under 18 years of age, those who are pregnant or breastfeeding, or those with an active cancer diagnosis.

Return To NAD+ North Shore Homepage

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Do you have any known allergies?* This field is required.

Yes

No

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Please list any known allergies:* This field is required.If none, enter “None.”

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Are you currently taking any medications?* This field is required.

Yes

No

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Please list your current medications:* This field is required.If none, enter “None.”

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Please provide any additional medical information or health history you would like us to be aware of:If not applicable, leave blank.

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Have you ever performed a self-injection before?* This field is required. If this is your first time performing a subcutaneous injection, don’t worry. Your NAD+ kit includes a detailed instruction guide and step-by-step video tutorials to help you feel confident.

Yes

No

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Do you understand the possible effects associated with self-administering subcutaneous NAD+ injections?* This field is required.

Yes

No

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Possible temporary effects may include flushing, warmth, lightheadedness, mild nausea, or minor injection-site reactions such as redness, bruising, tenderness, soreness, stinging, slight bleeding, or a small temporary lump. These effects are typically mild and short-lived. As with any injection, proper injection technique, hand hygiene, and vial preparation help reduce the risk of infection.

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Thank you for completing our Intake & Eligibility Screening.

Your responses have been received. Please click Submit below to finalize your screening. You will then be automatically redirected to our Shop NAD+ page to view our available packages and complete your purchase.