Forms

Below are the forms that An Optimal You requires for all initial consultation
appointments:

• Medical Consent (Registration) Form
• Email Informed Consent Form
• Financial Responsibility Agreement Form
• Preferred Communication Contact & Authorization Form
• HIPAA—Patient Privacy Form
• Office Policies Form

The additional service forms located below, will also be require by An Optimal You

for initial consultation service appointment type:

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Bio-Energy Testing

• Instructions for Bio-Energy Testing Prior to Appointment Form
• Bio-Energy Medical History—Female Form
• Bio-Energy Medical History—Male Form

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Bio-Identical Hormone Replacement Therapy (BHRT)

• Consent for BHRT Form
• BHRT Medical History—Female Form
• BHRT Medical History—Male Form

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I.V. & Ozone Therapy

• Consent for I.V. & Ozone Therapy Form
• I.V. & Ozone Medical History—Female Form
• I.V. & Ozone Medical History—Male Form

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Prolozone Therapy

• Consent for Prolozone Therapy Form
• Prolozone Pain Questionnaire Form
• Prolozone Medical History—Female Form
• Prolozone Medical History—Male Form