Pre-Intake Dripdok

Dripdok was Indonesia's first NAD, peptide, exosomes and regenerative therapy clinic founded in 2017 and publicly launched in 2019.  Read more here: https://dripdok.com/about-dripdok-iv-therapies-in-bali-indonesia/

Medical Disclaimer: The content provided here is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider with any questions you may have regarding a medical condition.

The initial step in our process is to gather subjective baseline data, which is crucial for tailoring your treatment plan effectively. Depending on the initial findings, we may require further blood testing. This ensures that we have comprehensive baseline data to guide your treatment, identify any potential contraindications, and customize your care with the utmost precision.

We're committed to providing you with the safest and most effective treatment plan, guided by thorough and careful evaluation.

Thank you for trusting us with your care.

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What is your first name? *
What is your last name? *
Whats. your date of birth? *
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What is your Whatsapp?  (please use country code for example +62-xxx-xxxxx) *
How Did You Find Us?
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Please rate your mood over the last 6 months *
poor
fantastic
How would you rate your cognitive abilities? (memory, names, places, events, etc)
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poor
excellent
Do you suffer from anxiety?
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none
It effects my personal life
Do you have changes in libido or fertility issues?
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no change
none at all
How is your gut health over the last 6 months?
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poor
excellent
Do you get 7-9 hours of sleep and is it quality (deep, rem, efficient and consistant)?
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no
yes
Rate your motivation and drive over the last 6 months
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poor, getting worse
strong as ever
Do you feel like you are looking older than you should be?
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Is your morning grogginess over 30min to 1 hour in the morning?
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Rate your current pain levels.
none
effecting my life
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Click 2 of the most important things you would like to focus on to start. *
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Do you have any health tracker? Apple Watch, Whoop, FitBit, Garmin, Oura Ring or other? *
What supplements or medications are you currently using?
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Do you have history of cancer? If yes, please elaborate shortly *
Have you had NAD+ before? If yes, please describe below (dosage, protocol, time - how long ago?) *
Is there any other health issues you have we should know?
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Whats your budget range for treatment? *

We’re pleased to offer free consultations because we understand how detailed and time-intensive the planning process can be. Knowing your needs and intentions in advance really helps us ensure that our time together is productive and valuable for both parties.

Thank you for your understanding and looking forward to our collaboration.

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