NOTE: If you've already filled out this intake form for Simple Hormones 2.0 . . . Thank you! There's no need to fill it out again.

If this is the first time you've seen this form, I'd love to get your input and your practice details so I can create your Simple Hormones 2.0 patient portal.

Thanks for subscribing to
Simple Hormones 2.0!

I'm grateful to get to help you educate your patients.

To get started with your Simple Hormones 2.0 subscription, I’ll need to gather a bit of information about you, your practice, and how you’d like to present your program to your patients. 

Get started with these 4 steps:

  1. Fill out the form below.
  2. Click the “Start Setup & Subscribe” button and check your email for a message with the subject “Important: confirm your Simple Hormones subscription
  3. Click the button in the email that says  “Confirm Simple Hormones Subscription
  4. Watch for more emails in the next few days, letting you know when your program is ready to send patients through.

Once we receive your setup information, we’ll build a “Patient Portal.” Your patients will visit the portal web address (url) and click a button to start viewing the video programs.

Steve Smith, MD’s patient portal address would have the name “smith” at the end, like this,

Choose any name you want at the end of your patient portal address. Try to keep it short and memorable, like

NOTE: When you subscribe to Simple Hormones, you're also agreeing to receive emails from me about patient education in general and your programs specifically. Please check your “spam” or “promotions” folder to make sure you receive the important emails about your program. Unsubscribe at any time. But please be aware that you may miss important emails if you unsubscribe.