Ready to Support Natural Growth Hormone Production with CJC-1295 & Ipamorelin?

Fill out this quick form to see if you're eligible for the Performance 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 history of cancer or malignancy that is currently in remission? *

Yes

Do you have a known hypersensitivity or allergic reaction to any medications/products? *

Yes

Please list the medication/product(s) below:

Do you have uncontrolled diabetes? *

Yes

Do you have untreated sleep apnea? *

Yes

Do you have diabetic retinopathy? *

Yes

Have you been diagnosed with any cardiovascular disorder such as heart failure? *

Yes

Do you have any form of active malignancy? (cancer or tumor) *

Yes

Do you currently have an acute illness, or have you recently had a major surgical procedure (in the past 3 months)?

Yes

Have you ever been diagnosed with benign intracranial hypertension? *

Yes

First Name

Last Name

Date of birth

Phone

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