Patient Intake Form

This form is required before your first consultation with us, or if we have not seen you in the past 12 months.

Intake Form

Prescription Refill Request

If you need a refill for your 82m / 82f / Finasteride / or Propecia. Please fill out this form and we will process your refill the same business day if received before 3:00PM.

Refill Request Form