These forms are current as of 10/01/2021. Please fill out completely on your computer (pdf fillable form), then print the patient packet and sign. Bring the completed and signed form to your visit. The Provider will go over your blood work and will offer pelleting if you are a candidate.
Females: Please have your most recent mammogram report, and PAP report copies with you on the day of your consult (unless you are getting pelleted at your established Gynecologist Office where these reports are kept). Mammogram reports need to be dated within the last year. PAP reports need to be dated within the last three years.
Males: If you have a known prostate issue, please have a letter of clearance from your Urologist. If your PSA is above 2.5, you may not be pelleted on the day of your consult.