New Patient Forms

We're excited to welcome you as a new patient! To make your first visit seamless, we kindly request that you complete the necessary forms provided below. Please bring your completed forms with you to your appointment. We look forward to seeing you!

Contact Us

Required Forms for All New Patients

Please ensure these forms are filled out before your scheduled appointment. If you haven't completed them beforehand, kindly arrive at least 15 minutes early to complete them in person.

Indemnification Clause

Download Form

Patient Medical History and Intake Form

Download Form

Pre and Post Visit Instructions

Download Form

Privacy HIPAA Policies

Download Form

Patient Consent for Photography

Download Form

Release of Healthcare Information

Download Form

Store and Forward Telemedicine Information

Download Form

Filler and Botox Forms

If you have an appointment for filler or Botox services, please click the links below to download the relevant forms.

Filler Services Consent Form

Download Form

Neuromodulator Form

Download Form

Collagen PIN Microneedling

Download Form

General IV Infusion Forms

B12 and Lipotropic Injection Consent Form

Download Form

Ketamine Forms

Ketamine Informed Consent Form

Download Form

Ketamine Pre and Post Visit Instructions

Download

Ketamine Patient Tips for Positive Infusions

Download

Concierge Medicine Forms

Concierge Agreement Form

Download Form

Hormone Replacement Therapy (HRT) Forms

ADAM Questionnaire

Download Form

Initial Intake Form

Download Form

Male Informed Consent Form

Download Form

Patient Testosterone Therapy Form

Download Form

Supplement Instructions

Download

Workout Instructions

Download

Weight Loss Forms

GLP-1 Informed Consent Form

Download Form

Vitamin C Infusion Forms

High Dose Vitamin C Consent Form

Download Form

GPD6 Declination Form

Download Form

Have a question?

Contact Us