Ageless Men’s Health Downloadable 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.

Patient Registration (3671 downloads)

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.

HIPPA Notice of Privacy Practices (1632 downloads)

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.

Consent for Testosterone Replacement Therapy (2770 downloads)

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.

Health History Questionnaire (2314 downloads)

Financial Agreement

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

Financial Agreement (4826 downloads)

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.

Agreement to Not Use Any Other Testosterone Supplementation (1229 downloads)