Patient 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
• Notification of Verbal 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:

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

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

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

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