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To get started either fill out the safe and secure e-Sign Medical History Form or download the form and email to [email protected]. If you opt to, you can print out the form. Scan and e-mail it to: [email protected] or fax it to (502) 451-7737.
Lab Orders will be faxed to the lab closest to your home/work. We will make all of the necessary arrangements for you to have labs done.
Following Completion of all lab work and compilation of your “Health Baseline” you will be scheduled for an appointment with Dr. Peggy Fishman.
Your thorough completion of the following comprehensive personal data form, provides us with more detailed information about you to better customize your treatment.
All your personal data is encrypted and protected. It’s safe and secure!
1. First, click the button to view the form.
2. Fill out the information.
3. Click the blue ‘Click to Sign’ button at the bottom.
If you prefer to download our Medical History form and email it you can!
1. First, click the button to view the form.
2. Click the ‘Save’ button or the disk icon to save the form to your computer.
3. Fill out the information.
4. Save the document.
5. Email the completed form to [email protected]