Paperwork/Consents Needed for Female Biote Patients
Click on each link below, complete each page and submit.
- Female New Patient Form
- Female Health History & Symptoms
- HIPAA Information and Consent
- Pellet Insertion Consent
- Hormone Replacement Fee Acknowledgment
- What Might Occur After Pellet Insertion
- Post Insertion Instructions
- Request to Restrict Disclosure
- Patient Acknowledgement of Appointment Cancellation Policy
Paperwork/Consents Needed for Male Biote Patients
Click on each link below, complete each page and submit.
- Male New Patient Form
- Male Health History & Symptoms
- HIPAA Information and Consent
- Hormone Replacement Fee Acknowledgment
- Pellet Insertion Consent
- Post Insertion Instructions
- What Might Occur After a Pellet Insertion
- Request to Restrict Disclosure
- Patient Acknowledgement of Appointment Cancellation Policy
Paperwork/Consents Needed for Telemedicine Patients
Click on each link Below (either male or female forms), complete each page and submit.
- Female New Patient Form
- Female Health History & Symptoms
- Male New Patient Form
- Male Health History & Symptoms
- Telehealth Consult Consent
- Hormone Replacement Fee Acknowledgment
- HIPAA Information and Consent
- Request to Restrict Disclosure
- Patient Acknowledgement of Appointment Cancellation Policy
Paperwork/Consents Needed for Thyroid-Only Patients
Click on each link Below (either male or female New Patient Form), complete each page and submit.
- Female New Patient Form
- Female Health History & Symptoms
- Male New Patient Form
- Male Health History & Symptoms
- Hormone Replacement Fee Acknowledgment
- HIPAA Information and Consent
- Request to Restrict Disclosure
- Patient Acknowledgement of Appointment Cancellation Policy
Call the clinic at 806-676-5545 or email us at drjeffhormones@gmail.com if you have any questions.
