Support Healthy Hair & Skin with GHK-Cu

Fill out this quick form to see if you're eligible for the Hair & Skin Program. If you qualify, we'll guide you through the next steps to get started—no pressure, no commitments.

What is your gender? *

Male

Female

Are you currently pregnant or breastfeeding?

Yes

Do you have any form of active cancer that you are currently receiving chemotherapy or radiation to treat? *

Yes

Do you have any known allergies or sensitivities to copper or copper-containing products? *

Yes

Have you been diagnosed with Wilson’s Disease or any genetic disorder affecting copper metabolism? *

Yes

Do you currently use any of the following in your skincare routine? *

Vitamin A or retanoids (including tretinoin)

Vitamin C (topical or high-dose oral)

Alpha Hydroxy Acids (AHAs) or chemical exfoliants

No, I don't currently use any of these

Copper peptides may interact with certain skincare ingredients. Vitamin C can oxidize copper peptides, reducing their effectiveness. Retinoids and AHAs may also interfere with copper peptide activity.

Vitamin C products should be used in the morning while GHK-Cu injections should be administered in the evening. Avoid simultaneous use of GHK-Cu with retinoids or AHAs

I understand and acknowledge this guidance

Who referred you to this program? *

Name of provider, clinic, or individual

First Name

Last Name

Date of birth

Phone

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