"*" indicates required fields CompanyThis field is for validation purposes and should be left unchanged.Name*Phone*Email* Gender*GenderMaleFemaleNoticing a drop in energy, drive, or muscle tone?* Yes No Feeling drained, foggy, or less motivated?* Yes No Lost your edge—physically, mentally, or sexually?* Yes No Gaining weight or losing muscle despite your efforts?* Yes No Waking up tired, even after a full night’s sleep?* Yes No Has your sex drive declined, leaving you frustrated or disconnected?* Yes No Ready to feel stronger, sharper, and more like yourself?* Yes No What would it mean to wake up energized, balanced, and in control?* Yes No Struggling with brain fog, poor sleep, or feeling like you’ve lost your spark?* Yes No Does menopause or perimenopause leave you feeling unlike yourself?* Yes No Do you miss feeling confident, vibrant, and in control of your health?* Yes No Has your libido declined, and you don’t know why?* Yes No Tired of being told your symptoms are “just part of aging”?* Yes No Is your body changing in ways you don’t recognize—low energy, mood swings, weight gain?* Yes No Preferred Date MM slash DD slash YYYY Preferred TimeMorningAfternoonEveningLocationLaytonLehiTaylorsvilleMessage*Please use this form for general information purposes only. DO NOT send personal health information through this form. Specific patient care must be addressed during your appointment.Please complete the following form to request an appointment. Please also note that availability will vary depending on your request. Your appointment will be confirmed by phone by a member of our staff. Thank you!
