Required Forms

Before speaking with the Physician, every patient is required to complete a HIPAA Compliant Patient Information Form, a HIPAA compliant Symptoms Form and a HIPAA Compliant Informed Consent. Please click the links below to complete ALL of the required forms.

Prescriptions will not be submitted until the telemedicine conference and ALL forms have been completed.

Patient Information Form

Patient Symptoms Form

Patient Informed Consent

The following form are for In-Person Office Appointments only. Please do not complete these forms unless you are in the office at a scheduled appointment.

Patient Information Form

Laser Informed Consent

Neurotoxin Consent