Simple Wellness Forms & Patient Portal

Submit your forms online

Hormone Replacement Therapy (HRT) Consent Form

Secret RF Consent Form

Xeomin Consent Form

New Patient Intake Form

HIPPA Form

Patient/Provider Agreement

Patient Update Information

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.