Wellness & Peptide Interest Form

What are your wellness goals? Check all that apply:

The following are individual injectable peptides:

NAD - Supports DNA repair, brain performance, and mental clarity. MicB12 - Supports fat metabolism and liver function a great add in for weight loss clients. SERMORELIN - Fat loss, increased muscle mass, improved sleep and increased libido are among the many benefits. TESAMORELIN - Helps reduce stubborn abdominal fat, improve muscle tone, supports metabolism, promotes better sleep and recovery HEXARELIN - Supports cardiovascular health, fat loss and enhances muscle tone SS-31- Known for improving stamina, focus, and overall cellular health. GLUTATHIONE - A powerful antioxidant that detoxifies the body, brightens the skin, and supports immune and liver health. GHK-CU-BPC 157 -A regenerative peptide blend that promotes healing, collagen production, and tissue repair. L- CARNITINE - Helps convert fat into energy, enhances endurance, and supports metabolism. Promotes recovery, focus, and overall energy levels. RETATRUTIDE- An advanced metabolic peptide used in medically supervised weight-management programs to support appetite regulation, improved metabolic efficiency, and overall weight-loss support. WOLVERINE BLEND (BPC-157 + TB-500): supports the body’s natural recovery processes, helping promote tissue repair, reduce inflammation, and enhance overall physical resilience. GLOW (GHK-CU + BPC-157 + TB-500): supports advanced tissue repair and regeneration. Promotes healthy hair, skin and nails, skin renewal and helps control inflammation. SEMAX: supports cognitive function, focus, mental clarity, and stress resilience

The Following Are Peptide Stacks That Can Be Used Together:

Increased Energy & Focus - NAD + MICB12 Better Sleep & Recovery- SERMORELIN + GHK -BPC 157 add in Dream Dust sleep powder Weight Loss/ Fat Metabolism-TESAMORELIN + L-CARNITINE Muscle Tone & Athletic Performance -HEXARELIN add in Strength Creatine powder supplements Anti-aging & Longevity- NAD + SS-31 Glowing Skin, Laxity and Collagen Production - GLUTATHIONE + GHK-CU oral pills Healing & inflammation GHK-CU-BPC 157 + GLUTATHIONE add in Trumeric for pain & inflammation Detox & Antioxidant Support GLUTATHIONE + NAD add in Liver Boost oral supplements

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Peptide & Wellness Interest Form

Please complete the appropriate form below prior to your appointment. All submissions are reviewed by our medical team and do not guarantee approval or prescription.

Submitting a form does not establish a provider-patient relationship. All treatments and prescriptions require medical evaluation and provider approval.

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