Forms Library

Medical Records Release & Health History Form

HIPPA Policy for Your Review

Financial Policy for Your Review

Informed Consent for Testosterone Therapy

Testosterone Pre-Consultation Questionnaire

 Weight Loss Intake Form

 Testosterone Informed Consent

Informed Consent for Growth Hormone Peptides

Patient Facing Documents


  • ALL new patients need to complete and submit this form
  • Use this form for regenerative medicine pre-screen

Please print, complete, and submit Medical Records Release & Health History Form to [email protected] or 513-228-0077 (fax)

RestoreMD

Address

15 Cincinnati Ave,
Suite 5,
Lebanon, OH 45036

Phone

513-935-3980

Fax

Office Hours

Monday  

9:00 am - 5:00 pm

Tuesday  

9:00 am - 5:00 pm

Wednesday  

9:00 am - 5:00 pm

Thursday  

9:00 am - 5:00 pm

Friday  

9:00 am - 5:00 pm

Saturday  

Closed

Sunday  

Closed