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Full Name
as it appears on your ID or insurance
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Email Address
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Where do you live?
We currently serve patients in New York and Ohio. Please select your state of residence.
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What is your home address?
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Untitled checkboxes field
I’m ready to work with a menopause-certified provider who gets it and gets me.
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I want to understand my options, especially when it comes to prescriptions or treatments that support my body.
Midlife has been a lot. I’m just trying to feel more like myself again.
I think I might be in perimenopause and need guidance from someone who’s truly in the know.
I’m craving real community and connection. It would help to know I’m not navigating this alone.
Something else
What are your top wellness goals right now?
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What are your top wellness goals right now?
Lose weight
Get some rest
Relieve anxiety
Better sex
End hot flashes
Other
Please attach the front of your insurance card
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Please attach the back of your insurance card
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Click to choose a file or drag here
Size limit: 10 MB
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