The following checklist must be completed prior to starting the program.

  • Complete and submit your health questionnaire and release forms. Download
  • Send us a copy of your photo ID
  • Send us your recent blood work including total testosterone, free testosterone, estradiol, hematocrit, chemistries, PSA. Click here for test details. If you are unable to obtain these blood tests through your PCP, Defy Medical can order the blood tests for you.
  • Send proof of HIV infection either via Elisa/Western Blot/ PCR or a letter from your primary physician. If that is not available, please provide copies of your current pharmacy bill with HIV medications listed.
  • You must have a physical exam which has been completed within the past year. Results of this exam should be provided to Defy Medical. If you do not have a current physical exam, please use the Request for Physical Exam located within the health questionnaire. This can be taken to your medical provider (MD, DO, ARNP, PA-C) to request your physical exam.
  • Once you have completed and gathered each of the above documents, please fax or email them to Defy Medical  Fax- 813-445-7340   Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
  • Contact Defy Medical patient services to confirm they have received your documents and set up payment with a valid credit card.  813-445-7342

Obtain your discount code from patient services to receive special pricing


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