Confidential Men’s Health Consultation Form
Compounding pharmacists can help with many health issues that affect men of all ages.
Modern technology and innovative techniques allow healthcare providers to work with pharmacists to customize medications, which provide patients with medications tailored specifically for certain needs.
If you feel as though you could use help in specific issues relating to men’s health, fill out our consultation form below or click here to print out PDF version, then fax it back or bring it in. Your privacy is a top priority. This information is secure and is guaranteed to only go directly to the pharmacists.
For your convenience you can send your forms three different ways:
Fill out the online Men's Health form below and sent it straight to us in our secure submission form.
Print and fill out the PDF version for Men's Health and bring it in during your appointment.
Print and fill out the PDF version for Men's Health and fax it to us at 760.834.6297.
Your privacy is a top priority; this information is secure and will only go directly to the pharmacists.
Please complete the form below:
Fields marked with * are required.