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