ANTI-AGING, SEXUAL PERFORMANCE, AND LONGEVITY
MEDICINE MEDICAL QUESTIONNAIRE

To ensure your safety and the effectiveness of our wellness medicines and compounded products, a brief medical evaluation is required. This helps us confirm that the prescribed medication is the right fit for you. Completing this form is quick and easy - simply start by entering your contact information below.

If you are a returning client, you can bypass this step by contacting us directly at 833.DAYTRYP or by logging into your existing patient portal here.

Thank you for helping us provide you with the best care possible!