Female Bio-Identical Hormone Patient Forms
If you are visiting Allura for Bio-Identical Hormone Replacement Therapy please print and fill out the pertinent forms found below.
You may bring this paperwork with you to your Appointment –OR– fax (970.223.0860) it ahead of your appointment –OR– you may mail it –OR– scan and email it. Our email address is firstname.lastname@example.org.
Alternatively, you may arrive 45 minutes prior to your appointment and complete the paperwork at that time.
If the paperwork is NOT COMPLETE before the scheduled time of your appointment, you may only have time for the consultation and we may not be able to accommodate a pellet insertion during the appointment time.
PATIENT FORMS TO BRING WITH YOU TO YOUR APPOINTMENT:
- BIH Health History – Female
- BIH General Consent Form – Female
- HIPPA sheet
- Insurance Disclaimer
- Lab Disclaimer
ADDITIONAL PATIENT INFORMATION (NOT NEEDED FOR APPOINTMENT):
- Welcome Letter
- FAQ Sheet
- BIH Fees
- Post Insertion Instructions
- Sequence of Events – Female
- What to Expect Post Insertion – Female
As always, please feel free to call us, 970.223.0193, if you have any questions or have difficulty filling out the forms. We appreciate the privilege of serving your healthcare needs and look forward to seeing you soon.