New patient form

Let’s get to know you better.

Our intake form gives our medical specialists an overview of your past and present medical history. It’s also a legal requirement to have this document in your patient chart.

GENERAL INFORMATION

DRIVERS LICENCE INFORMATION

You will be asked to upload a copy of your driver license later in this form.

OTHER HEALTH ISSUES

REVIEW OF SYMPTOMS

HORMONE IMBALANCE SYMPTOMS

A healthier choice for a healthier you.

Don’t let low testosterone levels hold you back any longer. Contact us today to schedule a consultation and start feeling like your best self again.