Who recommended OT Men’s Health to you?

Let’s evaluate your treatment options.

Discover personalized solutions based on your goals, habits, and health history.

By clicking  “Start”, you agree that Overtime Men's Health and EONPro may use your responses to personalize your experience and for other purposes in accordance with our Privacy Policy. The information you provide will be used as part of your medical evaluation.

What are the main results you hope to achieve with this treatment?

This questionnaire helps us understand your medical history, lifestyle, and goals.

Similar to the form you fill out when you visit the doctor.

Remember:

Select the state you live in:

This is the state where your medication will be shipped, if prescribed.

What is your name?

This way, we can personalize your experience from the very beginning.

Basic Information

To check if you qualify, tell us your date of birth.

This helps us confirm that you meet the age requirements for treatment.

To begin treatment, you must be at least 18 years old. We verify your date of birth to ensure you meet this requirement and to provide safe and appropriate medical care.

Where should we send your treatment?*

Your address also helps us confirm if treatments are available in your state and if you meet local medical requirements. 

*If your prescription is approved.

*Only if applicable. Leave blank if you live in a house.

What is your current weight?

*Numbers only. Example: if your current weight is 140 lbs, enter 140 in the box.

What is your height?

Your weight and height information allows us to calculate your BMI (Body Mass Index), a key metric doctors use to determine if you qualify for treatment. This information is confidential and will only be used by authorized professionals to assess your medical eligibility.

How can we contact you?

We use this information to keep you informed about your treatment, send you important updates, and help you stay connected with your provider.

To help ensure patient safety, we need to verify your phone number. By providing it and continuing, you consent to receive text messages from EONPro for verification and other legally permitted uses related to your account and our services. This may include order confirmations, shipping updates, and messages from your provider. Message and data rates may apply. Message frequency may vary. Reply HELP for assistance or STOP to unsubscribe. Standard message and data rates may apply. These messages may include medical reminders, treatment updates, promotions, and other information related to your care.

What is your gender?

This medical information helps us properly assess your eligibility and determine the most appropriate treatment.

OT Mens provides medical care without discrimination.

We do not discriminate based on sex, gender, gender identity, sexual orientation, age, race, color, religion, national origin, marital status, disability, or any other characteristic protected by law. Your privacy and dignity are a priority at all times.

Do you currently take any medications, vitamins, or supplements on a regular basis?

What medications, vitamins, or supplements are you currently taking ?

Please list the name, and how often you take each one.

Do you have any known allergies or sensitivities, including to foods, dyes, medications, herbs, vitamins, or supplements ?

Are you currently using any of these medications or supplements ?

All our programs include

Do you have any medical condition or chronic illness?

This helps your provider get a complete view of your medical history. Include any condition that affects your blood pressure, heart, kidneys (including kidney stones), or liver, as well as conditions such as diabetes, high cholesterol, stroke, cancer, or gout.

What was your most recent blood pressure reading?

(If known, select the closest option.)

Have you previously used any hormone, peptide, or GLP-based therapies?

Have you self administered hormone, peptide, or GLP-1 injections before?

How often do you have 5 or more alcoholic drinks at once?

Alcohol can sometimes interfere with the effect of certain medications. It is important that your provider knows so they can give you the best possible guidance.

Do you have any allergies?

What are you allergic to?

Have you completed any blood work in the past 60 days? 

Please upload your latest blood work lab results