Ten minutes, and only the questions that apply to you.
The same things a clinician would ask in an exam room. Tell us what you're here for and the rest of the form adapts to it. Dr. Smith reads every answer personally, and being reviewed costs nothing.
You started this before. Pick up where you left off?
Do you live in Arizona?
Dr. Smith is licensed in Arizona, so today we can only care for Arizona residents.
What are you here for?
Pick everything you're interested in. The rest of this form only asks what's relevant to your choices.
Do you work in fire, EMS, or law enforcement?
Shift schedules and sleep debt change how a plan gets built.
A little about you
What would you most like to change?
Select all that apply.
Health & safety
A provider who asks is a provider doing their job. These are the few absolute rules.
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Do any of these apply?
Select all that apply. Most of these don't rule anything out — they help build a safe plan.
Tobacco or nicotine use?
Alcohol, on a typical week?
Medications and allergies
Everything you take regularly, including over-the-counter and supplements. If none, write none.
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What are you requesting?
Pick what you'd like to be considered for — one or more. Your provider reviews your history and prescribes it when it's appropriate for you.
Prices shown are per vial or bottle. How long one lasts depends on your dose, and it can change if your dose changes — but the price per vial never does.
No payment is collected today. If approved, you'll receive an invoice — you only pay once you decide to move forward.
Anything else your provider should know?
Lab work
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Have you had blood work in the last 90 days?
A PDF, a photo of the printout, or a screenshot from your patient portal — whatever you have. You can also send them later to {{ supportEmail }}.
No problem — not everyone needs labs, and your provider decides if yours are required. If they are, we'll send an order to Sonora Quest and you'll pick a location and time that works. The lab cost is quoted on your invoice at our negotiated rate, so you never get a separate bill from the lab.
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Arizona addresses only. Plain packaging, nothing on the outside that says what's inside.
Your GLP-1s and peptides are picked up in person in Gilbert. Once your order arrives we'll message you and you choose a time — including hours that work around a shift.
Who should the answer go to?
Your review typically comes back within 24–72 hours.
How would you rather hear from us?
Private and encrypted. We never sell your information.
Your answers, in plain sight.
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Submitting doesn't charge you. Dr. Smith reviews your history and prescribes when it's appropriate for you. If approved, you receive one invoice covering the product and any required labs — nothing is charged before then.
One photo of your ID.
Your assessment is in. Before a prescription can be written, we verify your identity and that you're 18 or older — a driver's license, state ID, military ID, or passport.
Uploading…
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Stored encrypted with your medical record and used only to verify who you are. Never shared, never sold.
Your assessment is already with us — this step only verifies who you are. Would rather not upload it here? Email it to {{ supportEmail }} or bring it to pickup. Nothing can be prescribed until we have it.
You're in good hands.
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Questions in the meantime? {{ supportEmail }} or text 480-470-0493 — a real person answers, and anything clinical goes to your provider.
Thank you for being honest with us.
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That isn't a brush-off — it's the standard of care doing its job. We'd encourage you to talk with a provider in person, and your answers here are a good starting point for that conversation.
You haven't been charged anything.