Charlottes fountain of youth Charlotte, NC

Enrollment Form

Payment not required at this time.
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*Minimum purchase 2 month supply*
*Minimum purchase 2 month supply*
*Minimum purchase 2 month supply*
*Minimum purchase 2 month supply*
*Please select one of the two options*

Should you require assistance with enrollment at any time please contact our support team at 980-220-3361 or

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After clicking enroll now you will receive a confirmation email containing your enrollment package with instructions to perform the following:

  • Provide payment information
  • Complete intake forms
  • Upload necessary documents
  • Schedule a consultation with a physician
Click or drag a file to this area to upload.
Circadian Rejuvenation is a licensed non-diagnostic preventative health care provider. Our doctors and medical staff directly prescribe all required tests and review and confirm all test results. We may also perform physical exams, consult with primary physicians, and validate and verify submitted medical information. Patients who are found to have issues and symptoms of a legitimate medical and/or health condition are referred to a medical specialist in the specific required field for diagnosis and treatment in a specialized and monitored program. Circadian Rejuvenation reserves the right to recommend and use internal and/or external medical specialists for any patient. All patient information will be protected under governing HIPAA rules and regulations. Circadian Rejuvenation is not an internet pharmacy and does not dispense, ship, or distribute medications from our facility or website. Any and all medication prescribed by our doctors and/or associated medical will be dispensed from a US FDA-approved pharmacy. All patients are required to fulfill and follow all of the medical instructions and procedures prescribed by doctors and contact us immediately if they have any problems. Patients who are found to have submitted fraudulent information will be terminated from any health program offered by Circadian Rejuvenation. Any medication prescribed is only for the use of the patient and is not to be transferred, distributed, modified, or used by any other person(s).