Get Started Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 4What are you interested in at Med Matrix? Click all that apply Path1 *HormonesPeptideFunctional MedicineAdvanced TestingMed SpaIV TherapyHair RestorationSemaglutideIM ShotsAll of it!Not SureNextChoose One Where are you looking for help? *SleepWeight LossChronic PainOverall VitalityStrengthAuto ImmuneLong Haul CovidDietPreventative MedicineCancerOther (please describe)PreviousNextYour Name *FirstLastPreviousNextYour Phone Number *Your Email Address * Your help? Other MailingListConsent *I agree to be contacted by Med Matrix through the information provided. This will only be used for our direct communication with you. We will never share or sell your private information.PreviousSubmit Get Started Step 1 of 11 9% 1. What areas of your health are you most focused on improving? *(Required) Lose weight More energy Improve sleep Libido / sexual function Improve recovery Mental clarity Mood / motivation Preventative medicine Hormone balance / optimization Pain relief / joint pain Better focus / brain fog Healthy aging / longevity Gut health / digestion Reduce inflammation Better skin / hair health Reduce dependency on medications Other (Select all that apply) Choose as many as you like 2. Which of the following best describes your health goals? (Select all that apply)*(Required) I want to prevent disease now, feel confident about my long-term health, and stay active for my work, family, and hobbies. I want health care based on ME and NOT what's "average" so I can perform my BEST in daily life. I want health care based on ME and NOT what's "average" so I can perform my BEST in daily life. I want the best medicine has to offer, a medical team that cares, personalized care and access to advanced testing, peptides, HRT, regenerative medicine etc. 3. What do you feel you need the most support with right now to improve your health?*(Required)Please be thorough; this helps us customize our plan 4. What’s happening in your life right now that’s made improving your health a top priority?*(Required)Feel free to include symptoms, concerns, past treatments, or goals. 5. Do you currently have an address in Maine or New Hampshire?*(Required) Yes No We can only work with patients 18+ who have a ME or NH address 6. This is a paid program. If you qualify, are you prepared to invest financially in your long-term health if it feels like the right fit? *(Required) Yes, I have the resources to invest in myself Maybe, I have the desire / ability to find the resources needed to invest in my health No, I do not have the resources to invest in myself (Med Matrix does not accept insurance) 7. First Name*(Required)First name* 8. Last Name*(Required)Last name* 9. Email*(Required) 10. Phone*(Required) 11. Last Question - On the following page, you will be able to schedule a call with our team. After working with thousands of patients, we are certain we can help you. But we can NOT help you if you do NOT show up to the scheduled call. Will you commit to attending your selected time slot and showing up in a quiet place ready to work on your health?*(Required) Yes, I understand and can fully commit to attending No, I am not able to fully commit at this time (By submitting this application you agree to our terms of service)