New Patient Onboarding
Patient Intake Form
Takes less than 5 minutes
Complete your intake online before your consultation. Our providers review your information in advance so we can make every minute count.
Step 1 of 4
About You
Let's start with your personal information. All fields marked * are required.
Contact Preference
How Did You Hear About Us?
Step 2 of 4
Health Background
Help your provider prepare by sharing your medical history. All information is confidential.
Current Medical Conditions
Medications & Allergies
Surgical History
Hormone Therapy History
Step 3 of 4
Goals & Concerns
Tell us what brought you here. The more specific you are, the better prepared your provider will be.
Describe Your Symptoms
Step 4 of 4 — Almost there!
Your Appointment
Tell us how and where you'd like to be seen. Our team will confirm your slot within 1 business day.
Scheduling Preferences
Consent & Authorization
Form Submitted Successfully!
Thank you for completing your patient intake form. A Body Symmetry MD care coordinator will contact you within 1 business day to confirm your appointment and next steps.
We review your intake — your provider reads your health history and goals before your appointment.
We contact you within 1 business day to confirm your appointment date, time, and location.
Lab work (if needed) — some therapies require initial bloodwork. We'll walk you through this process.
Frequently Asked Questions
Questions About the Intake Form
Everything you need to know before getting started.
The form is divided into four short sections and takes approximately 3–5 minutes to complete. You can pause at any point — progress is preserved in your browser session.
Yes. All information submitted through this form is encrypted using 256-bit SSL, stored securely, and handled in strict accordance with HIPAA privacy regulations. Your data is never shared with or sold to third parties.
Completing the intake form before your consultation allows our providers to review your health history in advance and make the most of your appointment. We recommend completing it at least 24 hours before your scheduled visit.
A Body Symmetry MD care coordinator will contact you within 1 business day to confirm your appointment, answer any questions, and walk you through any next steps — including lab work if applicable to your treatment plan.
Yes. This form is fully optimized for mobile devices. You can complete it on any smartphone, tablet, or computer with equal ease.
You'll need basic personal information, a list of current medications and known allergies, and a general description of your health history and treatment goals. No insurance information is required — Body Symmetry MD is a cash-pay practice.