BEARIT Co. TRT PROGRAM POWERED BY PETER M.D.

Please complete the following application. If you qualify, a member of Bearit Co. or Peter M.D will reach out to you. Please be aware, incomplete applications will not be reviewed.

Full Name *

Phone *

Email *

State you live in *

Your Age *

Are you currently on testosterone replacement therapy? *

Do you have recent bloodwork showing your testosterone levels? *

Why do you feel you should be accepted for this program? *

Do you have children? *

Are you willing to meet for a virtual interview? *

Please describe a significant life event that has brought you to complete this applicantion for medical assistance. *

What department were you in / are you with? *

Upload your DD214 here *

Please upload a picture of yourself and a picture of your family. *

Please submit a video of yourself describing the reason you are applying. *

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