Activate Longevity - Registration Form

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Complimentary Longevity Modalities *

InBody Scan

Resting Altitude Therapy

Cryotherapy

Red Light Therapy (15 min)

Live O2-Active Altitude Training

Vasper

Premium Longevity Modalities (Available for Purchase at EO Preferred Pricing) *

Mobility Assessment ($50)

VO2 Max Test ($165)

Bodywork (55 min) ($245)

EMTT (30 min) ($100)

Shockwave Add-On ($60)

Winback TECAR Add-On ($60)

HOCATT Sauna ($175)

Brain Map Pt 1 Assessment ($795)

Perform IV ($280)

The Cure IV ($270)

Jyzen Cocktail IV ($260)

Meyers IV ($220)

NAD IV 250 ($220)

Vitamin D Injection ($40)

Vitamin B12 Injection ($40)

Vital Defense Injection ($90)

BPC-157 Peptide (Doctor Consult Required, Price TBD)

Semaglutide GLP-1 Peptide (Doctor Consult Required, Price TBD)

The one or two modalities/technologies I'm most interested in trying are: *

Which of the following would you like to prioritize? *

Change in body composition or weight loss

Reducing brain fog or energy issues

Reducing pain and inflammation

Other

Additional Comments