STEP 1

What brings you here?

There's no wrong answer. This just shapes what we talk about first.

Select all that apply *

Hormone Therapy - Men+Women (Testosterone replacement, energy, strength, libido, etc.)

Medical Weight Loss (Loss of muscle, gained fat, hard to lose)

Peptides (Recovery, sleep, tissue repair. Shorter path, labs only if needed)

Comprehensive Bloodwork only (Full panel & provider review. No treatment required)

Not Sure

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STEP 2

Where are you?

Location *

STEP 3

How do we reach you?

First Name *

Last Name *

Email *

Phone *

We’ll text a code to confirm it. By providing your number, you agree to receive text messages from Summit Rejuvenation about appointments, treatment updates, lab results and account notifications. Message frequency varies, typically 4–8 per month. Message and data rates may apply. Reply HELP for help or STOP to opt out at any time. Consent is not a condition of purchase.

Address

Street Address *

City *

State *

Country

ZIP *

🔒 Summit uses industry-standard encryption. Your information is stored securely and never sold.

STEP 4

The basics.

Gender *

Date of birth *

Height (Ft) *

Height (Inches) *

Weight *

Thanks. That is useful. Even one or two of those is worth measuring properly.

Symptoms on their own do not tell you the cause. Bloodwork on its own does not tell you how you feel. Your provider reads them together.

Then let us get you a proper baseline.

Most people have never seen their own hormone panel.

A full hormone and metabolic panel in one draw, and someone who sits down and explains what they mean. Whatever you decide afterwards, you will be deciding from information rather than guessing.

Bloodwork without a conversation is not much use.

Yours will come with one.

Fifteen to thirty minutes with our medical staff, going through what matters in your results, then asking how you have actually been feeling. That is where anything gets decided.

STEP 7

A Quick Health History.

Please select any/all items you have dealt with in the past - Your Health History

STEP 8

How do you feel about starting treatment?

I'm ready to get started

I'd like to learn more first

STEP 10

What are you taking?

Medications, supplements, vitamins

List everything with dose and frequency. Please include biotin, DHEA, and anything testosterone-containing. These change lab results.

Are you taking, or have you taken, TRT, HRT or any self-directed cycle?

If yes, please write what and how much. If no, just write no.

Any allergies to food or medications?

Optional

STEP 11

A few last things.

What would a good outcome look like for you?

In your own words. Ex) More energy, sleeping properly, getting strength back, losing weight that won't shift, feeling like yourself again - whatever it actually is.

How did you hear about us?

Are you active or retired military, a veteran, or a first responder?

Yes

Whatever the numbers say, they're yours to keep.

Plenty of people take their panel and never come back. That's a good outcome too.

Your provider will tell you honestly whether treatment is right for you, including when the answer is no. That's the whole reason we measure first.

STEP 12

Had bloodwork recently?

Upload Your Recent Labs

PDF or photo · drawn within the last three months

What we can and can't work from

- Our panel is deliberately broad, so labs from elsewhere are sometimes thinner than what your provider needs. A clinic that ran total testosterone and nothing else has not told you much, and it has not told us much either.
- At-home finger-stick kits are convenient, but the results are not always reliable enough to dose a controlled medication from. Your provider will tell you honestly whether yours are usable.
- Anything drawn more than three months ago needs redoing before treatment. Hormones move, and a stale baseline is worse than no baseline.
- Upload whatever you have. If it works, you have saved yourself a draw and the cost of one. If it doesn't, we'll say so and explain why.