How to Sign Required Forms with DocuSign | Instructional YouTube Video
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REQUIRED Click here to fill-out your MEDICAL HISTORY FORM and sign with DocuSign |
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FOR WOMEN ONLY! WOMEN, also fill-out and sign the MEDICAL HISTORY SEC.1B form. |
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REQUIRED • Medical Management Form & Authorization to Release Information to Myself |
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REQUIRED Fax us a copy, or email a high-resolution photo of your DRIVER'S LICENSE FAX: (561) 658-6212 EMAIL: documents@andrologix.com |
DO NOT COMPLETE THE FOLLOWING FORMS UNLESS SPECIFICALLY REQUESTED TO DO SO.
Some forms may require Acrobat Reader. Click here to download reader now.
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DOCU-SIGN ELECTRONIC SIGNATURE Telehealth Consultation Consent - Partner Physician (DocuSign online) |
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PRINT, COMPLETE, SIGN AND FAX PBPM Annual Medical Review Form |
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PRINT, COMPLETE, SIGN AND FAX PBPM Annual Lab & Vital Signs |
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PRINT, COMPLETE, SIGN AND FAX Tesofensine Consent Form |
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PRINT, COMPLETE, SIGN AND FAX Semaglutide Consent Form |
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DOCUSIGN ELECTRONIC SIGNATURE Semaglutide Consent Form (DocuSign online) |
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PRINT, HAVE COMPLETED BY EXAMINER, AND FAX - [Vitals Form for 3rd party Examiners] Universal Annual Lab & Vital Signs |
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PRINT, COMPLETE, SIGN AND FAX Medical Management & Authorization to Release Information to Myself |
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PRINT, COMPLETE, SIGN AND FAX Medical Records Release to 3rd Party |
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DOCUSIGN ELECTRONIC SIGNATURE Medical Records Release to 3rd Party (DocuSign online) |
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PRINT, COMPLETE, SIGN AND FAX Trimix Instructions and Consent Form |
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PRINT, COMPLETE, SIGN AND FAX 3rd Party CC Authorization |
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PRINT, COMPLETE, SIGN AND FAX Credit Card Authorization Only |
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OPTIONAL Required Lab Work |
DO NOT complete any of the following unless you are a new or existing patient of our West Palm Beach, Florida affiliate clinic.
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MUST BE COMPLETED BY EXAMINING PHYSICIAN AND FAXED BACK TO US TeleHealth Physical Exam Form - PBPM |
| CHOOSE ONLY ONE OF THE FOLLOWING: Print and Fax, OR Sign Online: | |
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MUST BE PRINTED, SIGNED AND FAXED BACK TO US TeleHealth Consent Form - PBPM |
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DOCU-SIGN ELECTRONIC SIGNATURE CAN BE SIGNED ONLINE TeleHealth Consent Form - PBPM |
DOXY.ME VIDEO VISIT INSTRUCTIONS:
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PDF DOCUMENT: DOXY.ME TELEHEALTH VIDEO VISIT INSTRUCTIONS How to Check In for my TeleHealth Visit with DoxyMe |
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2-MINUTE VIDEO: DOXY.ME TELEHEALTH VIDEO VISIT INSTRUCTIONS How to Check In for my TeleHealth Visit with DoxyMe |
INSTRUCTIONS FOR PHYSICIANSLAB URINE TESTS:
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INSTRUCTION VIDEOS FROM PHYSICIANSLAB Collection Instructions for Male & Female Urine Tests |
Andrologix Health and Wellness is a National Network of experienced physicians who specialize in hormone replacement therapy – it’s all we do. For over 18 years we’ve been improving the lives of thousands of men and women just like you!
Contact us today and let us create a custom therapy designed to address your specific needs. Balanced hormone levels are an essential part of an active lifestyle, a lifestyle that promotes good health, vitality and longevity.
At Andrologix Health and Wellness, we're committed to ensuring that your privacy is protected at all times. Your information is kept 100% confidential and will never be shared with a third party, for any reason, ever!
If you have any questions, please contact us at 877-741-6069.
For more information on the following subjects, please click the links below.
Therapies cannot be provided unless your physical exam, medical history, and lab work show a clinical need. Completing the required forms, lab work and exams doesn't automatically qualify you for treatment. Only the prescribing physician can determine if you qualify.
The content of this website is provided for informational purposes only and should not be construed as medical advice. Consult your healthcare provider before starting any therapy program.
