Step 1 of 5

Start your intake

Fill out your information below. The physician will contact you by text or phone to verify it before your visit.

What you'll need

• Full name
• Date of birth
• State of residence (New York or Connecticut)
• Phone number
• Email address
• Your condition / relevant medical information
• Government-issued photo ID (CT patients may also need proof of residency)

✓ 100% refund if you don't qualify for certification.

Intake form

Full name

Date of birth

State of residence

Phone number

Email address

Condition / relevant medical information

Photo ID isn't uploaded here — after submitting, text a photo of your government-issued ID (CT patients: also proof of residency) to (347) 822-9973.

Optional: pay now

You can pay upfront to streamline scheduling, or wait until after your information is verified.

Pay Now — 1-Year ($119) Pay Now — 2-Year ($219)

Opens Stripe's secure checkout in a new tab. Payment is kept separate from your health information.

What happens next

We verify

The physician contacts you by text or call to confirm your information.

Payment

If you haven't already paid, you'll get a secure Stripe payment link.

Your visit

A phone or message-based evaluation — video if needed.

Certified

NY: emailed & registered automatically. CT: state emails you to complete registration.