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New Patient Intake Form

For your first visit, please download the following three forms and bring the completed form with you.

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Women's New Patient

FEMME CLINIQUE PATIENT INTAKE FORM Download
FEMME CLINIQUE FEMALE PATIENT CONSENT HORMONE THERAPIES Download
FEMME CLINIQUE PATIENT PAYMENT AGREEMENT Download
Credit Card on File Billing Authorization Form Download

Men's New Patient

FEMME CLINIQUE PATIENT INTAKE FORM Download
FEMME CLINIQUE MALE PATIENT CONSENT HORMONE THERAPIES Download
FEMME CLINIQUE PATIENT PAYMENT AGREEMENT Download
Credit Card on File Billing Authorization Form Download

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