To expedite your visit, please save this fillable form to your computer and open it with Adobe Reader. Once you have completed the form, print a copy, initial where indicated and sign the last page. Please bring it with you to your next visit. If you do not have Adobe Reader, the form can be printed and filled out by hand.
For ALL Treatments, except Bio-Identical Hormone Replacement Therapy or the MonaLisa Touch, please complete the GENERAL HEALTH HISTORY FORM:
Also, please review the Allura Policies prior to visiting the clinic:
If you are visiting Allura for Bio-Identical Hormone Replacement Therapy please print and fill out the pertinent forms found below.
You may bring this paperwork with you to your Appointment –OR– fax (970-669-5348) it ahead of your appointment –OR– you may mail it –OR– scan and email it to hormonereplacement@alluraclinic.com.
Alternatively, you may arrive 45 minutes prior to your appointment and complete the paperwork at that time.
If the paperwork is NOT COMPLETE before the scheduled time of your appointment, you may only have time for the consultation and we may not be able to accommodate a pellet insertion during the appointment time.
If you are visiting Allura for Bio-Identical Hormone Replacement Therapy please print and fill out the pertinent forms found below.
You may bring this paperwork with you to your Appointment –OR– fax (970-669-5348) it ahead of your appointment –OR– you may mail it –OR– scan and email it to hormonereplacement@alluraclinic.com.
Alternatively, you may arrive 45 minutes prior to your appointment and complete the paperwork at that time.
If the paperwork is NOT COMPLETE before the scheduled time of your appointment, you may only have time for the consultation and we may not be able to accommodate a pellet insertion during the appointment time.
