New & Returning Health Profile (updated 10/16/2020)

New & Returning Health Profile (updated 10/16/2020)
Please let us know if you prefer a telehealth visit or an in-office visit. For in-person appt, you may book online via http://www.elevationweightloss.setmore.com
PLEASE NOTE THAT WE DO NOT SEND YOU ANY MAIL UNLESS YOU PROVIDE POSTAL MAIL-COMMUNICATION CONSENT.
Please email hello@elevationweightloss.com for more information.
Sign Here.
Sign Here
Sign Here
Sign Here. Write "NO" for no consent to B12/Fat Burner/Vitamin-C injections.
Sign Here. Write "NO" for no consent.
Sign Here
Sign Here. Write "NO" for no consent.
Sign Here. Write "NO" for no consent.
Click or drag a file to this area to upload.
If you cannot do this you may email your valid PHOTO ID to: hello@elevationweightloss.com
if yes, please email drcooper@elevationweightloss.com or call us 412-458-5042 to book a consult
By checking this box, I acknowledge that my consult may take 48 business hrs to process and our provider may not be able to schedule me for a consult until 14 business days after I submit my New Patient Form. I understand and accept.
Are you interested in getting started with Testosterone Replacement Therapy (TRT) through the use of injections, oral agents, and supplementary oral medications, including but not limited to: Sildenafil (Viagra) and tadalafil (Cialis) are used in both men and women. These two blood pressure agents are known as anti-hypertensive medications, help improve blood circulation, increase airflow and overall breathing through targeting specific receptors in the heart and lungs. These medications are used to prolong lifespan, improve long-term happiness, treat depression, and allow patients to feel better. DO NOT TAKE sildenafil (Viagra) and tadalafil (Cialis) if you are currently taking any nitrates medications. However, sildenafil (Viagra) and tadalafil (Cialis) are safe to use during pregnancy and/or breastfeeding.
You type here. Type "no" if you do not have any comments.
Sign Here