Patient Forms

The Youth Fountain – Patient Forms

At The Youth Fountain, we pride ourselves in providing the best patient experience possible. For your convenience, we have created printable forms that you can complete and bring to your first appointment. We have several different forms depending on the service you will be receiving. If you are unsure which form to fill out, please contact our office so that we can point you in the right direction.

The Youth Fountain Form Instructions

Please fill out each form to the best of your knowledge. We need to know as much information as possible to be able to help you in the best way we can. You will also be required to bring your ID to your first appointment. Click on the forms to the right to access them and feel free to contact The Youth Fountain if you have any questions or concerns.

AESTHETICS FORM HISTORY

Please fill out each form to the best of your knowledge. We need to know as much information as possible to be able to help you in the best way we can. You will also be required to bring your ID to your first appointment. Click on the forms below to access them and feel free to contact The Youth Fountain if you have any questions or concerns.

FEMALE BHRT FORM HISTORY

The Youth Fountain Female Anti-Aging Registration Packet consists of the patient’s general information, HIPAA disclosure form, and the intake forms. You will need to fill out these forms if you are a first time patient receiving Anti-Aging services. Please click below to access and fill out.

MALE BHRT FORM HISTORY

The Youth Fountain Male Anti-Aging Registration Packet consists of the patient’s general information, HIPAA disclosure form, and the intake forms. You will need to fill out these forms if you are a first time patient receiving Anti-Aging services. Please click below to access and fill out.

WEIGHT LOSS FORM HISTORY

The Youth Fountain Weight Loss Form History includes general patient information, HIPAA disclosure form, and the intake forms . You will need to fill out these forms if you are a first time patient receiving Weight Loss services. Please click below to access and fill out

SCHEDULE A VISIT TODAY: (732) 333- 5992

SCHEDULE A VISIT TODAY: (732) 333- 5992

PATIENT FORMS

The Youth Fountain – Patient Forms

The Youth Fountain Form Instructions

AESTHETICS FORM HISTORY

FEMALE BHRT FORM HISTORY

MALE BHRT FORM HISTORY

WEIGHT LOSS FORM HISTORY

Request a Consultation Today!

FIND OUT ABOUT OUR FINANCING OFFERS

Sign up for our eNewsletter!