Patient Forms

Name of FormDownload LinkPurpose
New Patient FormsClick to Download HereGeneral information needed for each new patient... i.e - Name, Address, City, State, etc...
Medical Records ReleaseClick to Download HereAllows you to give us the legal right to release sensitive Health Information to other health providers...
HIPAA AuthorizationClick to Download HereThis form grants us permission to discuss your medical care and/or leave phone messages regarding your care only (and ONLY) with the people you list. This includes your health information, laboratory results, test results & financial information.

HIPAA - Health Information Portability & Accountability Act

Female BioIdentical Hormone QuestionaireClick to Download HereThis female BioIdentical Hormone Questionnaire gives us both a good indication as to whether or not our RightBalance Hormone replacement therapy might be of help...
Male BioIdentical Hormone QuestionaireClick to Download HereThis male BioIdentical Hormone Questionnaire gives us both a good indication as to whether or not our RightBalance Hormone replacement therapy might be of help...
Votiva Informed ConsentClick to Download HereVotiva Informed Consent form (required)
Votiva Self AssesmentClick to Download HereThis form helps you determine if this procedure is right for you...
Votiva Patient InstructionsClick to Download HereVotiva Patient Instructions
(FormaV / FractoraV)
Votiva Video ConsentClick here to ViewA link to Dr. Bruce Dorr's Votiva Video Consent
- End of Patient Forms -

“The superior doctor prevents sickness; The mediocre doctor attends to impending sickness; The inferior doctor treats actual sickness.”

– Chinese Proverb