TRT Telehealth Intake Forms: Screening and Privacy

A TRT telehealth intake form should ask the patient's state and age first, then about the topics the FDA-approved testosterone labels flag for prescribers: symptoms, recent morning testosterone labs, cancer history, blood pressure, blood clots, heart, kidney and liver disease, sleep apnea, fertility plans, past steroid use and medicines, then consent. Every answer is health information, so it should stay out of ad pixels. Curve Forms hosts the intake under the BAA Curve Compliance signs on every plan, gives people outside your service area a kind end screen, and sends ad platforms a neutral form event, never the answers.

Book a call. See how your TRT intake would run in Curve Forms, or have Curve's team review your current intake funnel and what its pages send to Meta, Google and TikTok. Book a Curve Forms demo.

What the testosterone labels flag for clinicians

This guide uses four current FDA-approved labels on DailyMed: Depo-Testosterone (testosterone cypionate injection), AndroGel 1.62% (testosterone gel), Xyosted (testosterone enanthate injection under the skin) and Aveed (testosterone undecanoate injection). The prescribing clinician decides which questions to ask and who is eligible. The form only collects the answers.

AndroGel 1.62% is indicated for adult males with primary or hypogonadotropic hypogonadism, and its label says safety and efficacy "have not been established" in men with age-related (late-onset) hypogonadism or in males under 18 (AndroGel 1.62% label, section 1). The other three labels carry the same age-related limit.

Before the first dose, AndroGel 1.62% tells prescribers to "confirm the diagnosis of hypogonadism by ensuring that serum testosterone concentrations have been measured in the morning on at least two separate days and that these serum testosterone concentrations are below the normal range," and the Xyosted label uses the same words (AndroGel 1.62% label, section 2). So an intake form can ask for recent lab results as an upload. The table turns the rest of the labels into questions.

Label topic	What the label says	What an intake form can ask
Cancer	Contraindicated "in men with carcinoma of the breast or known or suspected carcinoma of the prostate" (AndroGel 1.62%, section 4)	History of prostate or breast cancer
Prostate	"Evaluate patients for prostate cancer prior to initiating and during treatment with androgens" (AndroGel 1.62%, section 5.4)	Enlarged prostate (BPH), urinary symptoms, a recent PSA result
Blood pressure	"Testosterone products are not recommended for use in patients with uncontrolled hypertension" (Depo-Testosterone, Warnings)	High blood pressure, blood pressure medicines, a recent reading
Blood clots	Postmarketing reports of "venous thromboembolic events (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE)" (AndroGel 1.62%, section 5.3)	Past blood clots in the legs or lungs
Heart, kidney, liver	Contraindicated in "Patients with serious cardiac, hepatic or renal disease" (Depo-Testosterone, Contraindications)	Heart failure, kidney disease or liver disease
Sleep apnea	Testosterone "may potentiate sleep apnea in some patients" (AndroGel 1.62%, section 5.12)	Diagnosed sleep apnea or CPAP use
Fertility	With large doses, "spermatogenesis may be suppressed through feedback inhibition of pituitary FSH" (AndroGel 1.62%, section 5.8)	Plans to have children
Past use	"Testosterone has been subject to abuse" (AndroGel 1.62%, section 5.6)	Past or current testosterone or anabolic steroid use
Medicines	"Androgens may increase sensitivity to oral anticoagulants," and "In diabetic patients, the metabolic effects of androgens may decrease blood glucose" (Depo-Testosterone, Precautions)	Blood thinners, insulin and other diabetes medicines
Gel at home	Boxed warning: "Children should avoid contact with unwashed or unclothed application sites in men using testosterone gel" (AndroGel 1.62%)	Children or a pregnant partner at home, when a gel is an option

The product changes the form. Aveed's boxed warning, on serious pulmonary oil microembolism (POME) reactions and anaphylaxis, says to "observe patients in the healthcare setting for 30 minutes" after each injection (Aveed label). Labels also change: the current Xyosted label lists its boxed warning on blood pressure as removed, with the warning kept under Warnings and Precautions. Write questions from the current label, and have the clinician sign off.

Testosterone is a Schedule III controlled substance

Federal law lists testosterone as a controlled substance. Under 21 CFR 1308.13(f), Schedule III anabolic steroids include "testosterone (17β-hydroxyandrost-4-en-3-one)," in any preparation containing it, "including its salts, esters and ethers." All four labels above carry the CIII mark.

That brings in DEA's telemedicine rules. Under the Ryan Haight Act, with certain exceptions, a practitioner may prescribe controlled substances remotely "only after conducting at least one in-person medical evaluation of that patient," as DEA and HHS explain in the fourth temporary extension published December 31, 2025. That rule is "effective January 1, 2026 through December 31, 2026." Until then, 21 CFR 1307.41 says "a DEA-registered practitioner is authorized to prescribe schedule II-V controlled substances via telemedicine" without an in-person evaluation when its conditions are met, including a legitimate medical purpose and an "interactive telecommunications system."

DEA proposed a special registration for telemedicine on January 17, 2025, and the fourth extension says the extra year gives DEA time "to promulgate a final set of regulations." For how these rules apply to your clinic, talk to your counsel. For the form: ask the patient's state early (see eligibility screening), and keep the intake easy to change.

Put the questions in an order people finish

Ask what decides eligibility first and the long history later, one step per screen (more in the intake questions guide and the intake funnel guide):

1. Eligibility. State and date of birth.
2. Contact details. Name, email and phone, once the person is invested.
3. Reason for the visit. Symptoms, from a list or in their own words.
4. Labs. Recent morning testosterone results, as an upload.
5. History. The label topics in the table above.
6. Medicines and allergies. Everything they take now.
7. Consent. Telehealth consent and the privacy notice, with marketing consent as its own checkbox.
8. Next step. A booking or checkout page.

Every answer on a TRT intake form is health information

A browser ad pixel on the page can collect what people type or select. HHS says tracking technologies on a regulated entity's webpage "that permits individuals to schedule appointments or use a symptom-checker tool without entering credentials may have access to PHI in certain circumstances." In its example, tracking code "might collect an individual's email address, or reason for seeking health care typed or selected by an individual," and then "the regulated entity is disclosing PHI to the tracking technology vendor, and thus the HIPAA Rules apply" (HHS bulletin on online tracking). The notice atop the HHS page says a June 20, 2024 court order vacated a different part, on IP addresses and public pages (the bulletin, annotated).

Ad platforms draw their own line. Meta's list of prohibited information includes "Sexual and reproductive health" and "Prescription medications," and it says the names of events and conversions "must not reflect, imply, or be based on any prohibited information" (Meta Business Help Center). If your TRT service is cash-pay, whether HIPAA applies is its own question (does HIPAA apply to cash-pay telehealth); Meta's terms apply either way. See what makes an intake form HIPAA compliant and intake form leak points.

What the form collects	Who needs it	May it reach an ad platform?
State and date of birth	The clinic, to screen eligibility	Never
Symptoms, history and medicines	The clinician	Never
Lab results and uploaded reports	The clinician	Never
Consent choices	Your records	Never
That the form was completed	Your ad platforms, to learn which ads bring patients	Yes, as a neutral event such as Lead, sent server-side

How Curve Forms helps with TRT intake

Curve Forms builds the flow above as a guided form, one step per card with a progress bar, hosted by Curve under the BAA it signs on every plan, so submissions never pass through a third-party form tool. Logic shows or hides questions based on earlier answers, so a follow-up about a past blood clot appears only after a yes. File upload takes PDF, JPG, PNG, WEBP, HEIC, DOC and DOCX, so a lab report can arrive as a photo or a PDF.

Screening outcomes send people to their own end screen by age (date of birth rules), service area (such as a state answer) or insurance. Screened-out submissions send no conversion to ad platforms, so the platforms learn from eligible leads. Privacy consent and marketing consent are separate checkboxes, and after submit the form can redirect to a booking or checkout page.

Each submission lands in the Leads inbox with its answers, UTMs, ad click ID and staff notes. Every view or export of submissions is logged. Form events, such as form started, step progress and form submission completed, reach Meta, Google Ads and your other destinations server-side through your event mappings. Form answers, page titles and free text are never sent, and step labels are stripped from step events. The step-by-step funnel shows where people drop off. For the wider funnel, see Curve for men's health and TRT clinics and men's health telehealth marketing.

Sources, checked October 14, 2026: FDA-approved labels on DailyMed for Depo-Testosterone, AndroGel 1.62%, Xyosted and Aveed; 21 CFR 1308.13 and 1307.41; Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities, 90 FR 61301 (December 31, 2025); Special Registrations for Telemedicine, proposed rule (January 17, 2025); HHS bulletin on online tracking technologies; and Meta Business Help Center, About prohibited information.

Frequently Asked Questions

What should a TRT telehealth intake form ask?

It should ask the patient's state and age, then about the topics the testosterone labels flag for prescribers: symptoms, morning testosterone labs, cancer history, blood pressure, blood clots, sleep apnea, fertility plans, past steroid use and medicines (AndroGel 1.62% label). The clinician sets the final list.

Is testosterone a controlled substance?

Yes. 21 CFR 1308.13(f) lists "testosterone (17β-hydroxyandrost-4-en-3-one)" among Schedule III anabolic steroids, "including its salts, esters and ethers," and the labels carry the CIII mark.

Can a TRT clinic prescribe testosterone by telehealth without an in-person visit?

Through December 31, 2026, 21 CFR 1307.41 lets a DEA-registered practitioner prescribe schedule II-V controlled substances via telemedicine without an in-person evaluation if its conditions are met, under the fourth temporary extension. Prescriptions must also follow "applicable Federal and State law," the extension notes. If it ends with no new rule, the in-person requirement returns, which DEA calls the "telemedicine cliff."

Should a TRT intake form ask for lab results?

It can. The AndroGel 1.62% and Xyosted labels say to confirm low morning testosterone "on at least two separate days" before starting. A file upload lets people send results; the clinician decides what is needed.

Can my Meta pixel see answers on a TRT intake form?

It can, if the pixel runs on that page. HHS gives the example of a "reason for seeking health care typed or selected by an individual" (HHS bulletin). Curve Forms sends a neutral event, never the answers.

Do TRT intake answers count as PHI?

On a HIPAA covered entity's website, generally yes: HHS says "IIHI collected on a regulated entity's website or mobile app generally is PHI" (HHS bulletin). For cash-pay services, see does HIPAA apply to cash-pay telehealth.

Can Curve Forms screen out people in states we do not serve?

Yes. Screening outcomes route people by service area (such as a state answer), age (date of birth rules) or insurance to their own end screen, and screened-out submissions send no conversion to ad platforms.

Talk to Curve Compliance

Book a call. Curve's team will build your TRT intake in Curve Forms, or review the intake funnel you run today, and sign a BAA on every plan. Most customers are live in about a week. Book a Curve Forms demo.