Front of ID

sf-required

Manage recurring validation states.
sf-form_input
sf-required
Field Input (Required)
sf-form_checkbox-field
sf-required
Checkbox (Required)
sf-form_radio-field
sf-required
Radio (Required)
sf-form_input-select
sf-required
Select (Required)
sf-form_input-date
is-icon-left-right
sf-required
sf-form-icon-left
sf-required
Date Input (Required)
This is an error tag
sf-form_input-error-wrapper
sf-required
Error Tag (Required)
sf-form-icon-right
sf-required
Icon on Input Right (Required)
sf-form-icon-left
sf-required
Icon on Input Left (Required)
sf-form-icon-right
is-text-area
sf-required
Icon on Input Right Text Area (Required)

sf-checked

Manage recurring checked radio & checkboxes states.
sf-form_checkbox-field
sf-checked
Checkbox (Checked)
sf-form_radio-field
sf-checked
Radio (Checked)

sf-focus

Manage recurring focusing for button, radio and checkbox states.
sf-form_radio-field
sf-focus
Radio (Focused)
sf-form_checkbox-field
sf-focus
Checkbox (Focused)

sf-hide

Manage hidden states.
sf-skeleton
sf-hide
Loader Box (Currently Hidden)

sf-await

Manage awaiting states.
sf-button-child
sf-await
sf-button-await-child
sf-await
Awaiting Status of Buttons
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

Next:

Finish your medical assessment to get Locklab

Answer a few quick questions and a Locklab physician will determine if treatment is right for you.
Continue
One moment...
Next Slide
Your birth date should be in MM-DD-YYYY format.
Please choose a state.
Select one option
(We will send a 6 digit code to verify)
Enter your phone number.
Please confirm your consent to proceed.
Continue
One moment...
As part of our efforts to ensure patient safety, we need to verify your phone number. By giving us your phone number and continuing, you agree that Locklab may send text messages to you to verify your phone number and for any other lawful purpose related to your Locklab account and your use of our services, including order confirmations, shipment notifications, and messages from your provider. Message and data rates may apply. Message frequency varies. Reply HELP for help. Reply STOP to opt out.
Next Slide
Select one option
Continue
One moment...
Next Slide
Select one option
Previous
Continue
One moment...
Next Slide
We want to know what has or hasn't worked in the past.
Select one option
This field is empty
Next Slide
Select one option
Next Slide
Select atleast one option
This field is empty
Previous
Continue
One moment...
Next Slide
Select atleast one option
Previous
Continue
One moment...
Next Slide
Select atleast one option
This field is empty
This field is empty
Previous
Continue
One moment...
Next Slide
Select atleast one option
Select one option
Previous
Continue
One moment...
Next Slide
Anything else we should know about?
Select one option
This field is empty
Next Slide
Please list the names, dose, and frequency for each medicine or supplement.
Select one option
    Enter your medications
    Previous
    Continue
    One moment...
    Next Slide
    Include any allergies to food, dyes, prescription or over-the-counter medicines (e.g., antibiotics, allergy medications), herbs, vitamins, supplements, or anything else.
    Select one option
      Enter your allergies
      Next Slide
      Before we finish up
      Select one option
      This field is empty
      Previous
      Continue
      One moment...
      End
      Thank you! Your submission has been received!
      Oops! Something went wrong while submitting the form.

      Last Step:

      Identity Verification

      Let's ensure you are who you say you are

      Our providers and pharmacy need one photo of your government-issued ID card - a driver's license, passport, or state ID card is best.

      We only use this information for identity verification and prescribing purposes.
      Upload Photo of ID
      (File size limit: 10MB)
      Uploading
      Remove
      Thank you! Your submission has been received!
      Oops! Something went wrong while submitting the form.
      256-BIT TLS Security
      HIPAA Compliant
      Assessment completed
      ID photo uploaded
      Next: Provider review
      within 12 hours

      Congrats on taking action!
      Here's what's next.

      A licensed provider is assessing your information to determine if Locklab is a good fit and will message you soon.
      Learn how your treatment works, ask your provider questions, and manage your plan from your Locklab portal.