Forms

Forms - RenewFx Health and Wellness, Houston, TX

Required Forms -Prior to Exam

Please download, complete and return completed forms with signature

Prior to meeting with a RenewFX Health and Wellness associate physician, all patients must first download complete, sign and email the below forms to support@renewfx.com. 

FORMS for download:

Instructions – Please download Forms, Complete and Email to support@renewfx.com or Fax to (877) 210-4335.

 

•Medical Treatment Agreement – Please review, sign and fax/email.

•Medical History Form – Please complete form, sign and fax/email.

• Women Only- Medical History Form Addendum (1B) 

•Medical Records Release to Myself –Please complete form, sign and fax/email.

•Credit Card Release Form – Please complete form, sign and fax/email.

Your information is protected by HIPAA and is completely confidential.

Click here to read our Privacy & Abuse Policy