Confidential BHRT Consultation Form
Our compounding specialists work together with patients and prescribers to provide customized bio-identical hormone replacement therapy that provides the needed hormones in the most appropriate strength and dosage form to meet each woman’s specific needs. Hormone replacement therapy should be initiated carefully after a woman’s medical and family history has been reviewed. Every woman is unique and will respond to therapy in her own way. Close monitoring and medication adjustments are essential.
If you feel as though you could benefit from Bio-identical Hormone Replacement Therapy, fill out our consultation form below or click here to print out PDF version, then fax it back or bring it in to your appointment. 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 Bio-identical Hormone Replacement Therapy (BHRT) form below and sent it straight to us in our secure submission form.
- Print and fill out the PDF version for BHRT and bring it in during your appointment.
- Print and fill out the PDF version for BHRT 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.