Hack My Age Podcast Attendees: The Better With Age Club Enquiry Form

The Better With Age Club

Thank You for Attending The Hack My Age Podcast with Zora Benhamou & Dr Lauren. Please complete this form to learn more and to receive your 10% podcast discount to and to secure your additional 20% discount on up to 2 additional memberships if you bring a friend.
Name

First NameLast Name
Date of Birth

MonthDayYear
Sex
Contact Number:
E-mail
example@example.com
Country
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please list your top 10 concerns regarding your health and well being.
I suspect or have been told I may have:

Hormonal ImbalanceThyroid DisorderMetabolic DisorderMitochondrial DisorderHeavy Metal or Mold ToxicityFoodAllergy or IntoleranceSIBO, Leaky Gut, CandidiasisInsulin ResistanceDiabetes or Pre-DiabetesCoronary Artery DiseaseHigh Blood PressureSleep Disorder
Have you had your Biological Age Tested ? ex Truage Trudiagnostic ? If so when and what was your result ?
Have you ever had Genetic Testing ? If so which one ?

23andmeSelf DecodeSelect SNPsOther
Have You Had a Saliva, Urine or Blood Hormone Panel in the Past 12 months.

YesNo
As a member of The Better With Age Club, I would like to learn more about:

Peptide TherapyWeight ManagementBioidenltical Hormone TherapyAge ReversalTruage Trudiagnostic Biological Age TestingRegenera Activa Hair TreatmentHeavy Metal Testing and TreatmentMold Toxicity and TreatmentHacking my health with GenomicsImproving my AppearanceImproving my EnergyImproving my Cognitive FunctionSports PerformanceProdrome Sciences Plasmologen Testing & Treatment for Preventing Cognitive DeclineImproving my Mood, Joy In LivingImproving My Love LifeOther
If you would like a representative to call you regarding The Better With Age Club Please let us know your preferred time for a call to learn more on Pacific Time : example: early am, weekdays, weekends, evening etc..
The Better With Age Club Membership. 1800 USD/Year or 175 USD/ Month

Includes:

Follow Up Truage Test Kit with Full Reports at Month 10

Day long in-person or virtual event with Dr Lauren Bramley

Virtual Truage Consultations x 2 with Dr Lauren Bramley

Club Pricing of 10% Discount on Therapeutics and Specialized Testing and Aesthetic Treatments

Does Not Include:

Initial Truage Test Kit 700 USD

Additional Consultations 250 USD

Prescriptions, Referrals, Therapeutics, Specialized Testing

Consultation Fees:

Better With Age Club Members:

Additional Consultation Fees 250 USD

Annual Prescription Fee Waived

Non Members

Consultation Fee 350 USD

Annual Prescription Fee 150 USD

Referral Fee For Radiology Investigations 100 USD
I am interested in the following cohort:

Whistler, August 6, 2022Miami August 15th, 2022Vancouver, August 20, 2022Ikaria, Greece THE BLUE ZONE September 24, 2022Victoria, Canada August 27, 2022Sydney November 15, 2022Melbourne November 22, 2022Las Vegas December 12, 2022I would like to hold a Private or Corporate event featuring The Better With Age Club
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The Better With Age Club 12 Month Membership - Less 10%You may enroll now or just submit this form if you would like more information. Buy up to 2 additional memberships for an additional 20% off of yours and theirs.
$1,720.00 Quantity

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