Request a Medication Refill
Use the form below to submit a refill request for your hormone, peptide, or other JRCU-managed medications. Our team typically responds within 1–2 business days. For urgent needs, please call (801) 996-3592.
Complete your intake paperwork online before your first appointment — this saves significant time at the clinic and ensures your provider has everything needed to build your personalized protocol.
New patient intake for exosome therapy, stem cell therapy, PRP, orthobiologics, and all regenerative joint treatments.
Regenerate Intake Forms (Coming Soon)New patient intake for hormone replacement therapy, peptide protocols, Class IV laser, and the full Optimize program.
Optimize Intake Forms (Coming Soon)EHR portal links are being finalized — direct form access will be added here shortly. In the meantime, call (801) 996-3592 and our team will send your paperwork directly.
What to Expect at Your Appointment
Forms Online
Photo ID
Review Your Case
Clear Plan
Don't see a specific form? Some documents are provided directly by our staff at your appointment. Call (801) 996-3592 or send us a message and we'll get it to you right away.