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. We receive many applicants per day, please complete each question with much thought.

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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