Basic Forms

Helping you look & Feel 10 years younger

Below are links to two forms. They are interactive PDF files, meaning you must download* them and fill them out in any PDF Reader. On the last page of each form is a SUBMIT button which will use your default email method to send the form data to us. You must then Click the SEND button as you would in sending an email. The attachment includes only the data entered and not the form itself so does provide a level of confidentiality. If the Submit button does not work for you, SAVE the completed file and attach it to an email sent to

Initial Intake Form

Hormone Balance Questionnaire
(Men, please complete only Sections A, B, F & G)

If you are unable to complete the form you can use the Save function to save your work on your computer. Reopen that file to return to the partially completed form. Use Ctrl++ or Ctrl– to Zoom In or Out to improve readability on your screen.

Please Note: These forms are rather long and detailed and are best completed on a computer or tablet with a keyboard. If you wish to try completing on a smartphone, your best choice is to use the free Foxit Mobile reader available in the Apple App Store or Google Play Store.

If you are having difficulties opening the files or do not have a PDF Reader, you can download a Free Foxit PDF Reader here:

Free Foxit Reader Download
(Decline any unneeded options)

*To Download a file, right click the form link above and use the “Save As…” Save Link As…” or “Save Target As…” link to download and save the file. If your browser is set to open files in a tab, the interactive feature will likely not work properly. After downloading, locate the file and open it to enter information.