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 (sign 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 Semaglutide + BPC-157 Consent Form |
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DOCU-SIGN ELECTRONIC SIGNATURE Semaglutide + BPC-157 Consent Form (sign 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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DOCU-SIGN ELECTRONIC SIGNATURE Medical Records Release to 3rd Party (sign 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.
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