Let's get your Women's Hormones intake started.

So your provider knows who they're treating and that we can prescribe in your state.

Please provide us with an email you check regularly. We may need to contact you about your care.

Since you're under 18, we'll need parental consent before any prescription is issued — either a parent/guardian joining your first appointment by Zoom, or a notarized permission-to-treat form emailed to support@simplefixrx.com beforehand. You can still continue this intake.

A couple of quick basics — we'll calculate your BMI for you.

Which of the following applies to you?

Check everything that applies to you right now.

Have you ever been diagnosed with any of the following?

Do you currently smoke or use tobacco?

Have you tried any of the following for weight management?

Almost done.

Do you have labs from within the last 60 days you'd like to share with your provider?

If yes, you'll be able to upload or send these after your intake is submitted.

We'll use this to confirm your consult and send next steps.