Request an invitation to Hastova Health

Full Name

Email Address

Age Range

Preferred Language

This helps us match you with the right group of members

Which medications or substances do you take?

For each medication you select, tell us how long you have been taking it.

Warfarin (Coumadin)

Levothyroxine (Synthroid)

Clozapine

Lithium

Methotrexate

Tacrolimus

Cyclosporine

Digoxin

Phenytoin (Dilantin)

Amiodarone

Isotretinoin (Accutane)

Mycophenolate

GLP-1 Medication (Ozempic, Wegovy, Mounjaro, Zepbound, or similar)

Peptides or Research Compounds (BPC-157, TB-500, Retatrutide, or similar)

Supplements and Vitamins

Other prescription medications

None of these

Other medications or health substances not listed above

How long have you been managing your health?

What is your biggest challenge managing your health between doctor visits?

Minimum 50 characters

⚠️ 50 characters required0 / 50 characters

Why do you want to be part of Hastova Health?

Minimum 100 characters

⚠️ 100 characters required0 / 100 characters

Do you have a caregiver or family member who helps you manage your medications?

YesNoI am a caregiver for someone else

Would you be willing to share honest feedback as a member?

Yes, definitelyI'll try my bestMaybe

How did you hear about Hastova Health?

Anything else you'd like us to know?

(Optional)

I'd like to receive updates about Hastova Health even if I'm not selected this time. I understand I can unsubscribe at any time.

Membership Application