VITALIT WELLNESS CENTER DOWNLOADABLE FORMS
You can help expedite your initial consultation with VitaliT Wellness Center by downloading and completing these forms.
Patient Registration
You can help expedite your initial consultation with VitaliT Wellness Center by downloading and completing our Patient Registration Form prior to your first visit.
HIPAA Notice of Privacy Practices
We are required by law to keep medical information about you private, to give you this notice of our legal duties and privacy practices with respect to your medical information, and to follow the terms of the notice that is currently in effect.
Consent for Testosterone Replacement Therapy
This consent form is your agreement to undergo testosterone replacement therapy, and must be completed prior to therapy being administered.
Health History Questionnaire
This form helps VitaliT Wellness Center gain a better understanding about your overall health. The more complete this form, the better our clinicians can tailor your treatment to you.
Financial Agreement
This form outlines how you intend to pay for your VitaliT Wellness treatment, including your insurance billing information.
Agreement Not to Use Other Testosterone Supplementation
This form is your promise to not combine other testosterone supplementation with your VitaliT Wellness Center treatment plan.
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