REQUIRED DOCUMENTS


Complete and Sign


MEDICAL HISTORY

Fill-out and sign your complete medical history online.


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FOR WOMEN ONLY

Women, please fill out this form and submit it along with your medical history.


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MEDICAL AUTHORIZATION

Fill-out and sign your medical authorization forms online.


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DRIVER’S LICENSE

Fax (561-658-6212) or email (documents@andrologix.com) a photo of your license.


Email

Optional Forms:

Please DO NOT complete any of the following forms unless you were specifically requested to do so.


PBPM Telehealth Forms:

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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YEARS EXPERIENCE

Improving the lives of thousands of men and women just like you!



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LOCATIONS

Skilled professionals in key metropolitan areas across the country.



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HAPPY HEALTHY CLIENTS

We have a long history of helping our clients take control of their health.


Main Office

701 Northpoint Parkway
Suite 140
West Palm Beach, FL 33409

Call (877) 741-6069

HRT Benefits:

• More Energy
• Less Body Fat
• Enhanced Libido
• Improved Mood & Memory
• Greater Confidence

*Andrologix Health and Wellness can only provide therapy services to patients who have a clinical need. To determine a clinical need, patients must complete any required lab work, physician consultations, examinations, and medical history review. Completing the required forms, lab work and exams doesn’t automatically qualify you for treatment; by law, only the prescribing physician can determine if you qualify for treatment. The claims, opinions, and statements made on this website are provided for informational purposes only and are not a substitute for professional medical advice, diagnosis, or treatment. If you have questions or concerns about your health, please consult your physician. The statements on this website have not been evaluated by the Food and Drug Administration, and are not intended to diagnose, treat, cure, or prevent any disease.