Online Consultation Request Form

I Have My Results, Now What?

Fill out and submit the form below and our staff will contact you to set up a personal and private phone consultation to review your results

Online Phone Consultation Request Form

Fields Market With An Asterisk "*" Are Required.

First Name * Last Name *

Day Phone * Night Phone

Fax Number E-Mail

Best Time To Contact You

Type Of Consultation Requested*

Quick Results Review – Approx. 10 Min.

-This consultation option allows the patient to speak with our compounding pharmacist/ bio-identical hormone expert which will review your results with you over the phone. The patient will also have a clear understanding of how their symptoms tie together with their levels.

Comprehensive Results Review and Bio-Identical Hormone Recommendation – Approx. 20 Min.

-This consultation option includes a thorough review of the patients results with our compounding pharmacist/bio-identical hormone expert. Our specialist will also provide the patient with a bio-identical treatment recommendation which TestMyHormones.com will then fax to your health care provider. Our specialist will also provide you with a BHRT compounding pharmacy which will fill your bio-identical hormone therapy prescription. This consultation is the most economical way to quickly get started with Bio-Identical Hormone Replacement. Patients can allow TestMyHormones.com to do all of the work and to provide their health care provider and compounding pharmacy with all of the information needed to get started quickly.

Thorough Results and Symptom Review and BHRT Recommendation – Approx. 40 Min

-This is the most thorough consultation and review. Our compounding pharmacist/bio-identical hormone expert will review your results, symptoms, past medical history, diet, current prescriptions, and supplements. Our specialist will also contact your health care provider with a prescription recommendation on your behalf and direct you to a compounding pharmacy to fill your prescription for bio-identical hormone replacement therapy if necessary.

Have you filled out an online Bio-Identical Hormone Evaluation? Yes No

Do you understand that there is a charge of $20 per 10 minutes of consultation time that is pro-rated to the minute, and that you will only pay for the time you use?* Yes No

If you are interested in having TestMyHormones.com contact your physician or health care practitioner with a recommendation for Bio-Identical Hormone Replacement please provide us with his/her information. If not please proceed to the end of the form and press submit.

Dr. Name Dr. Address

City State Zip

Phone Number Fax Number

Test Information

Type Of Test You Purchased *

Test ID # (Located In The Upper Right Hand Of Test Results

Please review the information listed above and press submit. The friendly TestMyHormones.com staff will contact you as soon as possible.

NOTE: California Residents - Business and Professions Code 1246.5 Requires That Any Test that has not been approved by the Federal Food and Drug Administration for sale to the public without a prescription as an Over-The-Counter Test kit must be ordered by a Licensed physician acting on a patient's behalf. All orders for test kits within the state of California

NOTE: New York State Residents New York State health law prohibits the testing of certain specimens collected in or mailed from New York, and prohibits the transmission of data from our laboratory to NY physicians or residents. Therefore, direct receipt of lab results for NY residents is not possible.

International Residents & Orders: Extra shipping charges may be added for international orders. Patients will be contacted by e-mail or telephone to approve charges.