To expedite your visit, please save this fillable form to your computer and open it with Adobe Reader. Once you have completed the form, print a copy, initial where indicated and sign the last page. Please bring it with you to your next visit. If you do not have Adobe Reader, the form can be printed and filled out by hand.
For ALL Treatments, except Bio-Identical Hormone Replacement Therapy, please complete the GENERAL HEALTH HISTORY FORM:
Also, please review the Allura Policies prior to visiting the clinic.
Bio-Identical Hormone Replacement Therapy
If you are visiting Allura for Bio-Identical Hormone Replacement Therapy please print and fill out the pertinent forms found below. 15-20 minutes may be required to complete all the forms. Please bring the paperwork to your appointment.
Please contact our office for lab orders that may be taken or faxed to your local lab.