Increase Health

TRT Patient Intake

Takes about 5 minutes. Fields marked * are required. Your answers go to the prescribing physician.

About you

Use your legal name and the address where your medication should ship.

Required for California patients.

Health history

The pharmacy needs your allergies and conditions on file before it can fill a prescription.

Testosterone questions

Most take one tap.

1Which symptoms do you have? (check all that apply)

2What's your main reason for wanting testosterone?

3Have you used testosterone, steroids, SARMs or hCG before, or are you using them now?

4Are you planning to father a child in the next 12 months?

5Have you ever had prostate cancer or breast cancer, or been told your PSA is high or you have a prostate lump?

6Do you have significant trouble urinating? (weak stream, getting up often at night, straining)

7Have you had a heart attack, stroke, blood clot (DVT or PE), or heart failure?

8Have you been diagnosed with sleep apnea?

9Do you have high blood pressure or a high red blood cell count?

10Do you take any opioids, steroid pills like prednisone, or other controlled substances?

Labs and ID

We need a recent morning total testosterone, plus a hematocrit and PSA. Don't have them? Choose "I need a lab order" and we'll send one before your visit.

We'll also confirm your ID and location at the start of your video visit.

Telehealth consent