Your next bio-identical hormone (BHRT) follow up is due shortly. As you know, the doctor will want to review test results with you at that time. In order for the doctor to order the most appropriate tests for you, we require the following e-form to be completed:
* denotes a required field
Note: We appreciate you taking time to complete this form. Please note that in order to provide prescription refills, we need this form completed, test results returned, and an appointment booked. It can take upwards of 2 months to have all the results in for your appointment.
Disclaimer: Submitting information through this form is voluntary and no guarantee can be made to the security of this form and website. If you prefer to provide the information by phone, please call The De Pieri Clinic at 250-448-7408. All information provided is considered to be confidential, privileged, and only for our internal use. It will not be published or redistributed.