Premium Consultation

Step 1 of 3

Please reply to a few questions in order to allow us to assist you as best we can.

Name and surname *
Date of birth *
Telephone number
Email *
City of current residence *
Professional occupation
Weight (kgs) *
Height (cms) *
Briefly describe your objectives *
Hormonal and sexual health background.
Previous diagnosis and treatments.
Additional relevant health issues.
Family history of medical diagnosis, ailments and treatments.
Do you have recent medical test results?
Dates and list of available medical reports.
Are you currently taking prescription drugs and/or health supplements?
Are you currently on any kind of diet?
Do you have allergies and/or diagnosed intolerances?
Do you have private health insurance?
Additional comments:

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