Patient Forms

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, please complete the GENERAL HEALTH HISTORY FORM:

Also, please review the Allura Policies prior to visiting the clinic:

Female Bio-Identical Hormone Patient Forms

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 (970.223.0860) it ahead of your appointment –OR– you may mail it –OR– scan and email it. Our email address is 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.

Patient Forms to Bring with You to Your Appointment:

Additional Patient Information (Not Needed for Appointment):

Male Bio-Identical Hormone Patient Forms

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 (970.223.0860) it ahead of your appointment –OR– you may mail it –OR– scan and email it. Our email address is 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.

Patient Forms to Bring with You to Your Appointment:

Additional Patient Information (Not Needed for Appointment):

As always, please feel free to call us, 970.223.0193, if you have any questions or have difficulty filling out the forms. We appreciate the privilege of serving your healthcare needs and look forward to seeing you soon.

GET A FREE CONSULTATION*

Just Call or Fill Out the Form Below

*Free Consultation offer not valid on Bio-Identical Hormone Replacement.

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