About Us
Get LathMized NAD+
- New Clinicians
- New Patients

First Name *

Last Name *

Phone *

Email *

Date of birth *

Biological Sex *

Biological Sex

Male
Female
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Height *

Height

4'10
4'11
5'0
5'1
5'2
5'3
5'4
5'5
5'6
5'7
5'8
5'9
5'10
5'11
6'0
6'1
6'2
6'3
6'4
6'5
6'6
6'7
6'8
6'9
6'10
6'11
7'0
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Weight *

Alcohol Intake *

Alcohol Intake

Low
Moderate
High
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Average Hours of Sleep Per Night *

Perceived Stress Level *

Perceived Stress Level

Low
Moderate
High
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Physical Activity Level *

Physical Activity Level

Sedentary
Low
Moderate
Active
Extremely Active
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What are you hoping to support with LNAD⁺? *

Energy & Stamina

Cognitive Clarity

Physical Recovery

Metabolic Resilience

Healthy Aging

Stress Tolerance

General Cellular Wellness

Other

Please list any past or current medical conditions *

Please list current prescription medications *

Please list current supplements or vitamins *

Safety Considerations *

Pregnant or breastfeeding

Undergoing chemotherapy or radiation

Recent organ transplant

End-Stage renal disease or dialysis

Active autoimmune flare requiring immunosupporession

Known allergy to NAD-related compounds

None of the above

Acknowledgement *

I understand LNAD⁺ is a dietary supplement and not a medical treatment.

This intake is used solely for informational, educational, and safety-screening purposes in connection with dietary supplement guidance. It does not constitute medical advice, diagnosis, or treatment.

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