Ageless Men’s Health Downloadable Forms

You can help expedite your initial consultation with Ageless Men’s Health by downloading and completing these forms.

Patient Registration

You can help expedite your initial consultation with Ageless Men’s Health by downloading and completing our Patient Registration Form prior to your first visit.

Download

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.

Download

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.

Download

Health History Questionnaire

This form helps Ageless Men’s Health gain a better understanding about your overall health. The more complete this form, the better our clinicians can tailor your treatment to you.

Download

Financial Agreement

This form outlines how you intend to pay for your Ageless treatment, including your insurance billing information.

Download

Agreement Not to Use Other Testosterone Supplementation

This form is your promise to not combine other testosterone supplementation with your Ageless Men’s Health treatment plan.

Download

Find an Ageless Men’s Health Clinic In Your Neighborhood

You’re only a few minutes from starting the path toward a fuller you. We can’t wait to see you stop by.

Find Your Clinic Today