Simple Wellness Forms & Patient Portal

Submit your forms online

CONSENT AND INSTRUCTIONS– Please fill out a consent form if you are scheduled for one of these procedures prior to your appointment. The form also contains important information to prepare for your visit.

Hormone Replacement Therapy (HRT) Consent Form

Secret RF Consent Form

Xeomin Consent Form

Patient Update Information

NEW PATIENTS– Please fill out these 3 forms at least 2 weeks prior to your appointment so we can be prepared to guide you on this wellness jouney.

New Patient Intake Form

HIPPA Form

Patient/Provider Agreement

Print your forms

Simple New Patient Intake Form (PDF)

Simple Registration, Simple Patient Provider Agreement, Simple HIPAA (PDF)

Patient Portal

We are thrilled to announce the launch of our brand new patient portal, designed to revolutionize your wellness journey. With this cutting-edge platform, you will have seamless access to a wide range of features and tools, empowering you to take control of your health like never before.

Our new patient portal is specifically tailored to enhance your overall wellness experience. Whether you are a long-time patient or new to our practice, this innovative tool will streamline your healthcare management and provide you with personalized support every step of the way.

To set up your account, email us or call us at 785-856-3030.