New Patient Intake Form
Every new patient, before your first appointment with us.
- Contact, emergency contact & insurance
- What brings you in, and what you want to get back to
- Medical & surgical history
- Medications, supplements & allergies
Before Your Visit
Patient Forms
Complete your paperwork at home, in your own time. Both forms fill out right in your browser — your answers never leave your device until you choose to share them with us.
Peptide & GLP-1 Questionnaire
Anyone starting peptide, NAD+, or GLP-1 weight-loss therapy with us.
- Medications, supplements & allergies
- Prior GLP-1, peptide, NAD+ & hormone therapy
- Screening history a physician needs before prescribing
- Your treatment goals
IV Therapy Informed Consent
Anyone receiving IV or infusion therapy in our wellness lounge.
- What IV therapy involves, and its risks & alternatives
- A short health screening for infusion safety
- Medications, supplements & allergies
- Your signed consent to treatment
How it works
Three steps, no account needed
- Fill it out Work through it a section at a time. Skip around, stop, come back — nothing is locked.
- Print or save it Finishing builds a clean summary. Print it, save it as a PDF, or download it as a text file.
- Bring it with you Hand it to our front desk when you arrive. That’s it — you skip the clipboard entirely.
Your privacy
How we protect what you write here
Nothing is transmitted
These forms don’t send your answers over the internet. Everything you type stays in your browser.
No tracking on form pages
We don’t load analytics, advertising, or session-recording scripts on any page that asks about your health.
You choose how it reaches us
When you finish, the form builds a summary you print, save as a PDF, or bring to your appointment.
Saving is opt-in
Your progress is only kept on your device if you switch it on — and a single button erases it.
Questions about your privacy? Read our privacy policy, or call us at 833-783-6561.
Prefer to fill these out with us?
Arrive fifteen minutes early and our front desk will walk you through everything on a practice tablet. Either way works.