Research Use Only. All products are intended strictly for in vitro research and laboratory experimentation. Not for human consumption, therapeutic use, or clinical application. For use by qualified researchers only.
Your information is encrypted and used only to match you with a licensed physician in your state.
Please enter your first name.
Please enter your last name.
Must be 18+ to qualifyMust be 18 or older.
Used for clinical screening onlyPlease make a selection.
Please enter a valid email.
Please enter a valid phone number.
Prescribing eligibility is state-specificPlease select your state.
Step 02 — Care Interests
What can we help you with?
Select everything that applies — your physician will address all of your goals in a single consult.
Please select at least one area of interest.
Step 03 — Health Background
Your health snapshot
This helps your physician personalize your protocol and screen for safety. All fields are confidential.
Sexual Health Safety Screening
⚠️Required for prescribing PDE5 inhibitors (sildenafil, tadalafil). If you take nitrates or have had a recent cardiac event, we cannot prescribe these safely.
Includes nitroglycerin, isosorbide mononitrate/dinitrate, or recreational nitrites ("poppers").
GLP-1 Safety Screening
Current Medications & Supplements
Allergies
Medical History
Select any conditions you have been diagnosed with:
Step 04 — Your Goals
What does success look like?
Help your physician understand what you're working toward. Be as specific as you'd like.
Please briefly describe your primary goal.
Timeline
Previous Experience
How Did You Hear About Us?
Step 05 — Review & Consent
Confirm your information
Please review everything before submitting. Your physician will receive this before your consult.
Personal Information
Name-
Date of Birth-
Biological Sex-
Email-
Phone-
State-
Care Interests
Selected Programs
-
Health & Goals
Height / Weight-
Activity Level-
Last Blood Panel-
Primary Goal-
Telehealth Consent & Patient Acknowledgment
By submitting this intake form, you confirm that the information provided is accurate and complete to the best of your knowledge. You consent to a telehealth consultation with a licensed physician affiliated with Hotspan who will review your intake and, where appropriate, issue a prescription or protocol.
You understand that the physician may decline to prescribe if the requested treatment is not medically appropriate for you. Hotspan and its affiliated physicians do not provide emergency medical care. If you experience a medical emergency, call 911 immediately.
Your personal health information is protected under HIPAA and will not be sold or shared with third parties except as required for your care, fulfillment of your prescription, or as required by law.
Compounded medications are not FDA-approved drug products. All prescriptions are issued by licensed U.S. physicians in states where telehealth is legally permitted. By proceeding, you acknowledge you have read and agree to Hotspan's Terms & Conditions, Privacy Policy, and Medical Consent Agreement.
Please check both boxes above to continue.
⚠️
We can't prescribe ED medication for you right now
Nitrate medications combined with PDE5 inhibitors (sildenafil, tadalafil) can cause a dangerous drop in blood pressure. For your safety, our physicians cannot prescribe these while you are taking nitrates.
You may still qualify for other Hotspan therapies — peptides, hormone optimization, longevity, or cognitive support — that don't carry this interaction risk.
⚠️
Please consult your cardiologist first
Following a recent heart attack, stroke, or serious arrhythmia, PDE5 inhibitors require clearance from your cardiologist before we can prescribe safely.
Once you receive that clearance, we'd be glad to help. In the meantime, you may still qualify for other Hotspan therapies.
⚠️
GLP-1 therapy is contraindicated for you
A personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia type 2 (MEN 2) is a contraindication for GLP-1 receptor agonists per FDA labeling.
You may still qualify for other Hotspan therapies. Please update your answers or contact us to speak with a physician.
✓
You're all set!
Your intake form has been received. A licensed physician will review it shortly.
Confirmation email sent to your inbox
Right now
Physician reviews your intake and selects a protocol
Within 24-48 hours
You receive a consult link and schedule your appointment
Within 48 hours
Physician issues your personalized prescription or protocol