SAMPLE
Sample document — all client details are placeholders

Youth Revisited Ltd

Sample document

TRT Programme — Patient Information & Schedule

This document is prepared individually for each client following consultation and clinical review.

Client name

[ Your full name ]

Date of birth

[ Your DOB ]

Reference

YRV-XXXXXXX

Programme

TRT + Monitoring Subscription

Prescriber

Nemia Pilobello — NMC IP

Medical Doctor

Dr Salman Ahmed — GMC #7948448

Pharmacy

SignatureRx — GPhC reg. 9012267

Contact

info@youth-revisited.co.uk

WhatsApp

+44 7927 989791

Section 1

What Your Subscription Includes

ServiceDetail
Blood TestingQuarterly venous blood panel — at our clinic or via phlebotomist home visit. Results reviewed within 1–2 days. AI-assisted clinical report reviewed and signed off by Nemia Pilobello.
Quarterly ConsultationOne consultation every 3 months with either Nemia Pilobello or Dr Salman Ahmed. Your choice, based on your needs. Included at no extra cost.
Testosterone MedicationYour prescribed compound dispensed by SignatureRx (GPhC reg. 9012267). Dispatched to your registered address following each prescription issue.
Needles, Syringes & Sharps BinIncluded and sent quarterly with your medication dispatch. For injection clients (Sustanon / Testosterone Cypionate) only.
Prescription ManagementPrescription issued by Nemia Pilobello following clinical review. Dose adjustments made only when clinically appropriate.
Personal ContactYour own named contact, Monday to Friday 9am–5pm, for questions about your programme, results, or appointments.
1:1 Injection TutorialA private Zoom session covering preparation, injection technique, site rotation, and aftercare — before your first administration.
Results DashboardPersonal dashboard showing all your biomarkers over time. Compare quarters, track trends.
Additional consultationsAvailable on request outside your quarterly review. Pricing varies — contact the team for details.

Section 2

What Is Not Included

Needles, syringes, and sharps bins for Testo Gel clients
HCG, aromatase inhibitors, or other ancillaries not part of your prescribed protocol
Medical letters, GP correspondence, or NHS referral letters
Specialist investigations unrelated to TRT or hormone health
General health concerns or conditions unrelated to hormone optimisation
Emergency or out-of-hours medical care — in an emergency call 999 or attend A&E
Important — scope of care: Any markers flagged in your results that fall outside TRT monitoring scope — such as kidney function, ferritin, or cholesterol — are flagged for your awareness only. Investigating or treating these is your responsibility and that of your GP or chosen specialist.

Section 3

Your Prescribed Protocol

Compound

[ Your prescribed compound ]

Protocol

[ Your dose & frequency ]

Route

[ Subcutaneous / IM / Topical ]

Duration

[ 12 weeks — then reviewed ]

Important: Your protocol is prescribed individually by Nemia Pilobello following clinical review of your blood results. Do not adjust your dose or frequency without consulting your prescriber. Store medication at room temperature away from direct light. Dispose of all needles in your sharps bin. Never share your medication.

Section 4

Your Baseline Blood Results

Sample date: [ Date of your test ] · Reviewed by Nemia Pilobello, Independent Prescriber

MarkerResultStatusClinical Note
Testosterone[ Your result ][ Status ]Confirmed by prescriber following review
Haematocrit[ Your result ]SAFEMonitored quarterly
Liver Function[ Your result ]CLEARNo concerns
Lipid Profile[ Your result ]CLEARNo concerns
PSA[ Your result ]CLEARNo concerns
Additional markersYour full panel results will appear here. Any markers outside TRT scope are flagged for your awareness only.
Scope of care: Youth Revisited monitors your hormone health and TRT. Markers outside TRT scope — such as eGFR, ferritin, and cholesterol — are included for your awareness only. Investigating or treating these is your responsibility and that of your GP.

Section 5

Your Monitoring Schedule

WhenPanelNote
[ Clinician specified ]As advised by your prescriberYour prescriber may request an interim test depending on your baseline results. Arranging this is your decision. We can assist as an additional service.
Every 3 monthsTotal Testosterone, SHBG, LH & FSH, Prolactin, FBC, Haematocrit, PSA, HbA1c, Liver Function, Lipid ProfileStandard quarterly panel — included in your subscription.

Section 6

Blood Test Preparation

Your blood must be taken no later than 10am — book your appointment as early as possible
Fast from the night before — no food from approximately 10pm. Water is fine.
Stay well hydrated — drink plenty of water the morning of your test
Blood is collected venously. You can attend our clinic or we send a phlebotomist to you.
Do not inject testosterone on the morning of your test — this affects readings

Section 7

Clinical Awareness — What to Watch For

Important: Youth Revisited is not an emergency service. In any of the situations below, contact your GP or call 999 first. Do not wait for our team to respond.

Contact your GP or call 999 if you experience:

Chest pain, shortness of breath, or palpitations
Signs of blood clot — leg pain, swelling, sudden breathlessness
Severe headaches or visual changes
Significant mood changes, depression, or aggression
Any injection site reaction that worsens or does not resolve

Between appointments: contact your personal contact Mon–Fri 9am–5pm. They will escalate to the prescriber where clinically needed.

Section 8

Your Subscription Terms

These terms are set out in full in your subscription agreement. This is a summary for reference.

Monthly fee

[ £95 / £150 / £175 / £195 / £325 depending on your plan ]

Billing

Monthly by Direct Debit via GoCardless — first payment 7 days after signing

Cancellation window

7 days from signing, before first DD payment and before any medication is ordered

After 7 days — Monitoring Only

Cancel anytime with 30 days' written notice to info@youth-revisited.co.uk

After 7 days — Medication tier

Once a quarterly prescription is issued, all 3 monthly payments for that quarter are committed. Cancellation takes effect at quarter end.

Biomarker upgrade

Optional — £100 per quarter, chosen ad hoc. Not a recurring commitment.

Additional consultations

Available on request. Pricing varies — contact the team.

Section 9

Contact & Support

Personal contact

Mon–Fri 9am–5pm

Programme questions, results, appointments

General team

WhatsApp: +44 7927 989791

9am–9pm, 7 days a week

Email

info@youth-revisited.co.uk

All enquiries

Emergency

Call 999 or attend A&E

Youth Revisited does not provide emergency medical care

Section 10

Informed Consent — Key Points

You will confirm these when you sign your subscription agreement separately.

Your document will look like this

Personal to you

Your schedule is prepared individually — your blood results, your protocol, your dosage, your monitoring plan. Book a consultation to get started.

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