Patient Forms & Required Documents
Completing your forms ahead of time helps us prepare for your visit and ensures a smooth, efficient experience.
Weight Management Forms
- Pre Screen Form
- Weight Management Pre Screen Form
- Weight Loss Consultation Intake Form
- Lipotropic and B12 Informed Consent
- Informed Consent for Medical Weight Loss Management
- BHW Consent for Photos and Measurements
- Authorization to Release Healthcare Information
- Indemnification Clause
- Office Policy
- HIPAA Privacy Policy
Hormone Replacement Therapy (For Women)
Testosterone Replacement Therapy (For Men)
General Forms
- DPC Membership Agreement
- 3-Month Follow-Up Form (Fees Apply)
- Self-Pay Lab Services
- Adult Annual Physical Form
- Prior Authorization Consent
- Disclosure Statement for Direct Primary Care
- Pre and Post IV Infusion Instructions
- BMI Calculator
- Anticoagulation Therapy Consent Form
- Disclosure Statement for Direct Primary Care