Forms

General Forms

General Patient Information Form (Requires HIPAA)

Weight Loss New Patient Intake Form (Requires HIPAA)

HIPAA Authorization

BHRT Female Packet

Therapy Management Agreement

HIPAA Authorization

BHRT Patient Agreement for Treatment

Female Checklist

Female Hormone Balance Checklist

Female Patient Questionnaire and History

Female Patient Questionnaire

Female Pellet Consent Form

BHRT Male Packet

Therapy Managment Agreement

HIPAA Authorization

BHRT Patient Agreement for Treatment

Male Checklist

Male Patient Questionnaire and History

Male Patient Questionnaire and Medical History

Male Prostate Exam Waiver for Testosterone Pellet Therapy

Male Testosterone Pellet Insertion Consent Form

SA Prime Wellness