Women's BHRT Evaluation Form

From a clinical management point of view, it is very useful to gain a detailed history of possible hormone deficiencies. All information provided will be kept confidential. After you fill out this evaluation a pharmacy representative will contact you to set up a consultation time with one of our pharmacist consultants at our Taylor Street location. There is an initial consultation fee of $150.00, payable at time of visit. The time allowed for an initial consult is 60 minutes. A saliva test is recommended prior initial consultations and at a minimum of once per year. Follow up consultations will be billed according to time allowed. Please see office policies for more details. Complete the below evaluation to get started.