Hormone Consult Questionnaire

This is the questionnaire that needs to be filled out prior to each hormone replacement therapy (HRT) visit. On the day of your visit we will take your regular medical record and vitals, as well as this hormone specific set of history we need to know.

Also, if you are on any current medications (including over the counter HRT creams, or other medications, please bring in all your bottles. It is extremely important that we know everything you are on, and this is the best way for us to get all that info. Please note we do not need your vitamins or other supplements.

Please understand that HRT lab testing is not part of our fee here in the office, and that it is your responsibility to call your insurance company to understand coverage for lab services.

Thank you, and we look forward to seeing you soon!