Please download and fill out the forms below.
When the paperwork is complete, please fax them to (904) 249-2047 or email them to firstname.lastname@example.org or you can bring them with you to your appointment. Please arrive 30 minutes early so we may process the paperwork.
- General Patient Information Form
- Health History Form
- Medication List
- Hormone Imbalance Questionnaire (required for Hormone Consultations)
- Policies and Authorizations
- Notice of Privacy Policies
- Bioidentical Hormone Replacement Therapy Informed Consent
- Prescription Protocol
- Informed Consent for Testosterone Replacement Therapy
For your appointment, please bring:
- Insurance card
- Driver’s license
- Any necessary referrals
- Completed paperwork, if not sent in advance
If your paperwork is sent in advance we ask that you arrive 20 minutes before your scheduled appointment time to process your health insurance. Please contact our office at (904) 249-3743 if you have any questions. Thank you and we look forward to seeing you soon!