Signup Sheet

At this time, telehealth eligibility in Alaska, California, Hawaii and Nevada is not available.

What is your first name?

Please use your legal name, no nicknames.

And your last name?

Your email address

Please don't use temporary emails. We don't SPAM anyway.

Your phone number

In case that we need to contact you.

Do you accept text messages?

Yes

No

Date of Birth?

MM-DD-YYYY

Birth Sex?

Male

Female

What brought you to IAM today?

Hormone Optimization

Peptide Therapeutics

Sexual Performance

Medical Weight Loss

Your Home Address

City

State

ZIP Code

Your Home Address

Do you have most recent lab work results?

I have labs

I don't have labs

Most recent means within 30 days.

File Upload

Maximum file size: 134.22MB

We accept lab results that are not older than a month.

ID Upload

Maximum file size: 134.22MB

To submit your driver's license or ID card, simply use your phone camera to take a clear picture.

How did you hear about IAM?

Referred by

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