Thank
you for contacting Olympic Surgical Associates. We
are dedicated to helping women and men who want to
take control of their health. Our focus is in
managing those who are currently experiencing
symptoms of peri-menopause/menopause and
andropause. For women, these symptoms may include
chronic fatigue, sugar cravings, hot flashes,
decreased libido and sleep disturbance to name a
few. For men, it may be decreased libido, elevated
triglycerides, fatigue, and decreased exercise
capacity.
Our clinic will help you with your journey through
this phase in your life. You will be approached in
a caring and holistic manner. On your first visit
we will not only review symptoms and discuss
concerns, but we will also discuss issues
concerning diet, potential need for vitamin
supplementation, exercise, and overall well being.
You can expect to be here for approximately 45
minutes.
Please fill out all of the initial paperwork in
black ink and bring it with you to your first
appointment. It will also be helpful to have a
copy of all recent laboratory work (within one
year) so that we may review it together and have a
copy for your chart.
As you can see, we believe in scheduling long
appointments to treat you in an efficient manner.
Our financial and cancellation policy is as
follows. One half of the fee is expected on the
day of service and we will also bill your
insurance. Credit on account will be applied to
the fee for a subsequent visit. Please notify us
48 hours prior to canceling an appointment or a
fee of $75.00 will be applied to your account.
Congratulations on taking your first step to a
more balanced life. Balancing hormones with real
hormones can make you feel more energetic, more
youthful and positive.
We look forward to seeing you. Thank you for your
cooperation.
Olympic Surgical Associates
Bioidentical Hormone Replacement Therapy Forms
(To view or print forms
click on text links below)
Consent for Care
Patient Information
Testosterone Questionnaire
ESS-Epworth Sleepiness Scale
Personal Health Survey
Andropause Self-Assessment Questionnaire
Female Sexual Function Index
Authorization for Release of Information of
Medical Records
One Physician per Authorization
Health Questionnaire
Pages 1-5
Health Questionnaire
Pages 6-10
International Prostate Symptom Score
New Insurance Information
Do You Have A Damaged Metabolism?
Mandatory Forms for All Patients-HIPPA
(To view or print forms click on text links below)
Acknowledgment of privacy Practices & Patient
Consent
Notice of Privacy Practices for Protected Health
Information
Cosmetic Forms
(To view or print forms
click on text links below)
Cosmetic Skin Care
Cosmetic Confidential Information & Consent for
Consultation
Cancellation Policy for Non Surgical Treatments
History and Skin Questionnaire |
