Patient Forms

Please fill out the forms requested by your doctor.

Content Forms

Body Rejuvenation Consent Form

Informed Consent for Hormone Replacement Therapy

Informed Consent for Nutrition and Herb Supplements

Informed Consent Delegating Physician and Delegate Performing  Medical Services 

Informed Consent for Testosterone or Dehydroepiandrosterone (DHEA) Therapy 

Informed Consent for Thyroid Hormone Resistance

HIPAA Notice of Privacy Practices


Female – Functional Medicine Questionnaire

Male – Functional Medicine Questionnaire

Office Location
100 N Federal Hwy
Suite 200
Hallandale, FL, 33009

Mon-Fri 6am-4pm
Saturday 8am-8pm
Sunday Closed