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Form For Everyone

All Crafted patients should fill this out.

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Demographics
What type of service are you interested in?
What do you want to improve?
What are you looking for?
Is your shipping address the same?
About You
What have you done to lose weight?
How often do you think you will want to come into the office? Remember you can always change this and we can send you home injections
Do you want your packages shipped in discreet packaging?
Your Background
Your Medical History
Vices - Do you?
Do you have any of the following complaints?
Who lives with you?
Have you done your labs in the past 30 days? If so, please upload here or text a picture to 830-465-3867
Upload File
Upload File
Many common ailments usually have really easy solutions. Crafted has quick and easy tricks for the following, do you suffer from any of these common complaints?
Common Sexual Complaints
Common Medical Complaints
Common Skin Issues
Insurance Info. Insurance is not required for Crafted, however if your meds are covered may decrease your monthly bill by $150. Either upload an image below or text a picture of the front and back of your insurance card to 830-465-3867 Upload us an image and we can see if your insurance approves it.
Do you have insurance?
Upload File
Upload Picture
Consents
Make sure to scroll to the bottom and click submit!

Thanks for submitting!

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