Quick Contact

Contact Us

Address:

Suite 1A, Level 2
802 Pacific Highway
Gordon NSW 2072
Sydney Australia

Phone:

02 8001 6558

Email:

admin@theicb.com.au

Take lifts to level 2 "Offices Level", either from the 802 Pacific Highway offices entrance or from the Gordon Centre Shopping Centre. The Gordon Centre parking entrance is on Dumaresq Street, off of Pacific Highway.

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Muscle Bulk

Peptide Program Registration

Please register your details to have one of our consultants come back to you with pricing and other relevant information. We look forward to assisting you with your health goals.

Personal Details
  
My CLINIC / AGENT IDENTIFIER

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Additional Information

Growth Hormone Peptide Medical Questionnaire

This Medical Questionnaire is designed to ensure that it is safe for you to commence a program of growth hormone (GH) secreting peptides. GH peptides and GH treatment have been proven to be safe and very effective, provided certain diseases are not present, overdoses are not consumed and possible side effects are checked. Please complete the requested sections and follow the prompts.

Yes    No

Please select your objective(s) *

     
     
     
     
     
     
     
     
     

Current High Risk Symptoms
Yes    No
Yes    No
Yes    No
Yes    No
Yes    No
Yes    No

Current Medical History
Yes    No
Yes    No
Yes    No
Yes    No
Yes    No
Yes    No
Yes    No

Past Medical History
Yes    No
Yes    No
Yes    No
Yes    No

Medications
Yes    No
Yes    No

Allergies
Yes    No
Yes    No

Muscle Definition
Weight Loss–Aggressive
Weight Loss–Moderate
Age Rejuvenation
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