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Medical Health Forms – Medical Wellness Center in Chevy Chase

We appreciate your interest in the services here at our medical wellness center in Chevy Chase, MD. Below, you’ll find three forms related to our hormone replacement therapy treatments—one form for men, one form for women, and a third form explaining what to do after inserting a hormone pellet.

We encourage you to check out the forms below, print off the appropriate form for the service you require, fill in the necessary information, and make sure that our professionals receive the form. We’ve worked hard to make these forms as intuitive as possible; however, we’re more than happy to answer any questions that you may encounter when filling them in. We’re always available to help you in any way that we can.

Don’t hesitate to reach out to us for more information about any of the questions or fields on these forms. We’ll take the time to listen to your questions and provide you with the details you need. Our goal is to make it as simple and streamlined as possible for you to receive the treatment that you need—and it all starts with a simple form. We look forward to hearing from and supporting you soon at our medical wellness center.

Patient Forms:

Male Hormone Replacement Targeted History
Female Hormone Replacement Targeted History
Pellecome Post Instructions Pellet Insertion

Bio-Identical Hormone Replacement Therapy (BHRT) Bio-Identical Hormone Replacement Therapy (BHRT) Bio-Identical Hormone Replacement Therapy (BHRT)

Millennium Medical

 is the therapeutic use of plant-based hormones that are identical on a molecular level with those created by the human body. Hormone pellets are often the preferred method of delivery and have benefits over other formulations, such as creams or orals. Sustained, consistent release of hormones from pellets over time is considered an advantage over the fluctuations that can occur with other formulations.

Pellecome Pellecome RE3