Patient intake form

Welcome to iollo — we're excited to have you join us on this journey towards better health!

Our blood test provides unique and deeper insights into your overall health by analyzing 500+ biomarkers. Using this information, we create personalized recommendations just for you, to help you feel your best.

To get started and avail of your iollo kit, simply complete this form and payments page. You will automatically be redirected to a payments page after completing this form.

Thanks again for choosing iollo. We can't wait to help you unlock a healthier, happier you!

What's your name?

What's your date of birth?

How often would you want to take a iollo test?

How would you like to receive your first testing kit? If you select 'In-Person Pick-Up Through My Physician' please have your physician directly provide you with a kit after your payment. On the next step, you'll be asked to choose whether your physician collects your sample at the practice or you self-collect it at home. If you select 'Home Delivery', we'll send your first kit directly to your home, free of charge, within 2-3 business days.

Future kits will be automatically shipped to your home address.

How would you like to receive your first testing kit? If you select 'In-Person Pick-Up Through My Physician' please have your physician directly provide you with a kit after your payment. On the next step, you'll be asked to choose whether your physician collects your sample at the practice or you self-collect it at home. If you select 'Home Delivery', we'll send your first kit directly to your home, free of charge, within 2-3 business days.Future kits will be automatically shipped to your home address.

A

In-Person Pick-Up Through My Physician

B

Home Delivery

Would you like to pay with an HSA/FSA card? 5% processing fee applies to HSA/FSA payments

I have read iollo's Consent for Sharing Health Data with my medical provider and do give my consent. By choosing to give consent to iollo's Consent for Sharing Health Data with your medical provider, you agree to let iollo share your health data, health results, and self-reported information with your medical provider, as detailed in iollo's Consent for Sharing Health Data with your medical.

A

I agree