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FORMS & QUESTIONNAIRES

Forms and Questionnaires

Before starting Bio-identical Hormone Replacement Therapy it is important that you understand the treatment requirements and how your consultations will proceed as they are done remotely.
 
Due to the ongoing Covid-19 pandemic all clinic consultations have been cancelled for the time being. This means that you can begin and continue your Bio-Identical Hormone Replacement Therapy treatment remotely only if you are able to see your own doctor at the beginning of your treatment and have regular health screenings done once (1) a year by a health care physician. This is required as a mandatory monitoring process of your well-being and health status during your treatment.

As a new patient you must fill out a Questionnaire, Patient Agreement Form and book a First Appointment in order to begin. 

Download Patient Agreement form

Your signature is required in writing so please print out this form and sign it before sending to Dr Paivi Shedd.

You must upload the signed form when you are booking your first consultation.

 

Fill in a Questionnaire


If you are a new patient and have booked a New Appointment with Dr Paivi, please fill out a patient questionnaire before your first appointment.
 
The following patient questionnaires will help Dr Paivi understand your health history, current health status and any medical concerns you may have. Also by filling out a questionnaire, Dr Paivi can assure the best care for you.

If you cannot answer some of the questions or feel uncomfortable answering them, leave them blank. At the end of the questionnaire you can upload any relevant patient/health files that you would like Dr Paivi to assess.

All questionnaires are confidential and only read by Dr Paivi.

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Dr Paivi Shedd is an A4M Fellowship, Board Certified doctor in Anti-Aging, Regenerative and Functional Medicine.