New Patient Appointment Booking

First Name(Required)

Last Name(Required)

Date of Birth(Required)

Low T treatment is not recommended for people under 25. If you would still like to seek treatment, please call and speak with an associate.

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Last 4 of SSN(Required)

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This information is used as a secure way to identify our patients.

Email(Required)

Phone(Required)

Appointment Reminder

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Location(Required)

Location *AR, FayettevilleAR, Hot SpringsAR, Little RockCO, Colorado SpringsCO, Greenwood VillageCO, WestminsterIL, Chicago – WestmontIN, GreenwoodIN, IndianapolisMO, IndependenceNC, PinevilleOH, DublinOH, GahannaOH, MasonOK, EdmondOK, TulsaTN, ChattanoogaTN, FranklinTN, HendersonvilleTN, Johnson CityTN, KnoxvilleTN, MurfreesboroTX, ArlingtonTX, Fort Worth – AllianceTX, Fort WorthTX, FriendswoodTX, FriscoTX, MansfieldTX, PasadenaTX, PflugervilleTX, PlanoTX, RichardsonTX, RockwallTX, South AustinTX, SouthlakeTX, SW San AntonioTX, The WoodlandsTX, TylerTX, West Houston

Appointment Date(Required)

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Appointment Time(Required)

Appointment Time *

Insurance

Save time at your appointment by filling out your insurance information. (optional)

Insurance Provider

Insurance ProviderAdvantage 360 NetworkAdvantage HealthAetnaAssurantAlliant HealthBlue Cross Blue Shield - BCBS ALBlue Cross Blue Shield - BCBS ARBlue Cross Blue Shield - BCBS COBlue Cross Blue Shield - BCBS FederalBlue Cross Blue Shield - BCBS ILBlue Cross Blue Shield - BCBS INBlue Cross Blue Shield - BCBS KSBlue Cross Blue Shield - BCBS MOBlue Cross Blue Shield - BCBS NVBlue Cross Blue Shield - BCBS OHBlue Cross Blue Shield - BCBS OKBlue Cross Blue Shield - BCBS PABlue Cross Blue Shield - BCBS TNBlue Cross Blue Shield - BCBS TXBoon ChapmanCignaCofinityCoresourceCoventryEquitable Plan ServicesFirst HealthGEHAGolden RuleGPAHealth AdvantageHealthchoiceMail HandlerMeritain HealthQualChoiceUMRUnited HealthcareWeb TPA

Relationship to the policyholder

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Group ID

Member ID

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Name

This field is for validation purposes and should be left unchanged.

Terms & Conditions For Promotional Offers: At the discretion of Low T Center locations, periodic promotions or discounts may be offered to prospective new patients on their first visit to a Low T Center. Offers to discount health service fees for new patients are intended for adults age 30+ and may not be combined with any other offers. Offers may be cancelled at any time at the discretion of Low T Center.