Welcome!
Please complete the following medical history form so we can order your lab work and schedule your appointment with one of our board-certified providers once your results are received.
Important Information:
If you complete this form after regular business hours or on the weekend, you will receive your lab order form and instructions on the next regular business day.
We require relevant laboratory work prior to your initial consultation and every 6 months thereafter. Your lab work is included with your signup and monthly membership at no additional charge (unless you request labs beyond our standard comprehensive panel).
After we review your information and receive your completed lab results, we will ensure you have everything needed before your provider visit.
Once you have your initial consultation, you are under no obligation to continue services if you choose not to. If you decide to continue, your monthly membership will begin after your initial consultation.
Your monthly membership covers comprehensive hormone labs every 6 months, all follow-up appointments, and your provider reviewing your refill assessments every 60 days and processing your refills. Medications, additional labs, and other testing are billed separately. We typically prescribe medications in 60-day increments.
No contracts — You may cancel at any time as long as you provide us with 48 business hours notice.
All paid membership fees are non-refundable.
We look forward to welcoming you to the No Limits Family!
Clinic Policies:
We use Quest Diagnostics exclusively for all lab work.
We are a cash-pay only clinic. We do not accept insurance, bill insurance, provide letters of medical necessity, or complete any insurance forms.
You are welcome to use your HSA card, but we cannot guarantee that your specific HSA plan will cover our services.
We only work with FDA-regulated compounding pharmacies in the United States and do not call in prescriptions to local pharmacies.
Please be sure to fill out ALL the required fields (marked with a *). You will have difficulty submitting the form if all the required fields are not filled out.
Please read and agree to our Compounded Medications information HERE
Please read and agree to our Membership Information HERE
Please choose one of the options below to proceed. Thank you and welcome to the No Limits Family!
1 hour initial provider visit with a Nurse Practitioner. Labs for this option are included at no charge: Females - Сomplete Blood Count with Differential, Comprehensive Metabolic Panel, Testosterone, Sex Hormone Binding Globulin, Progesterone, Estradiol (E2), FSH and LH, T3, Free, Thyroid Peroxidase, Vitamin B12, Vitamin D, Standard Lipid Panel, Hemoglobin A1C, Fasting Insulin. Males - Сomplete Blood Count with Differential, Comprehensive Metabolic Panel, Testosterone, Sex Hormone Binding Globulin, PSA, Estradiol (E2), Prolactin, T3, Free, Thyroid Peroxidase, Vitamin B12, Vitamin D, Standard Lipid Panel, Hemoglobin A1C, Fasting Insulin
1 hour initial Medical AND Coaching Session with one of our coaches and Nurse Practitioners. Labs for this option are included at no charge: Females - Сomplete Blood Count with Differential, Comprehensive Metabolic Panel, Testosterone, Sex Hormone Binding Globulin, Progesterone, Estradiol (E2), FSH and LH, T3, Free, Thyroid Peroxidase, Vitamin B12, Vitamin D, Standard Lipid Panel, Hemoglobin A1C, Fasting Insulin. Males - Сomplete Blood Count with Differential, Comprehensive Metabolic Panel, Testosterone, Sex Hormone Binding Globulin, PSA, Estradiol (E2), Prolactin, T3, Free, Thyroid Peroxidase, Vitamin B12, Vitamin D, Standard Lipid Panel, Hemoglobin A1C, Fasting Insulin
1 hour initial provider visit with a Nurse Practitioner and EXTENSIVE labs. Labs for this option include our standard panel at no charge in addition to additional, even more comprehensive, labs: Сomplete Blood Count, Comprehensive Metabolic Panel, Estradiol (E2), Lipid Panel, PSA, Total (male), Sex Hormone Binding Globulin, Testosterone (free and total), TSH, T4 - free, T3 - free, Thyroid Peroxidase Abs (looks for Hashimoto's thyroiditis), Vitamin B12, Vitamin D, 25-OH - total, Cortisol, FSH, LH, CRP-HS (looks for overall inflammation), Magnesium, Insulin - Fasting, Hemoglobin A1c, Iron Binding Capacity - Total, DHEA-Sulfate.
1 hour initial Medical AND Coaching Session with one of our coaches and Nurse Practitioners. Labs for this option include our standard panel at no charge in addition to additional, even more comprehensive, labs: Сomplete Blood Count, Comprehensive Metabolic Panel, Estradiol (E2), Lipid Panel, PSA, Total (male), Sex Hormone Binding Globulin, Testosterone (free and total), TSH, T4 - free, T3 - free, Thyroid Peroxidase Abs (looks for Hashimoto's thyroiditis), Vitamin B12, Vitamin D, 25-OH - total, Cortisol, FSH, LH, CRP-HS (looks for overall inflammation), Magnesium, Insulin - Fasting, Hemoglobin A1c, Iron Binding Capacity - Total, DHEA-Sulfate.
Please see the following links for our Terms and Conditions, Privacy Policy, and Cancellation and Refund Policy.