AMIR SALIM MD PA

Integrated Medicine
&
Aesthetics

AMIR SALIM MD PA Integrated Medicine & AestheticsAMIR SALIM MD PA Integrated Medicine & AestheticsAMIR SALIM MD PA Integrated Medicine & Aesthetics

Home
Services
About Us
FORMS & INSTRUCTIONS
SUPPLEMENTS
Contact Us
TELEMEDICINE
More

AMIR SALIM MD PA

Integrated Medicine
&
Aesthetics

AMIR SALIM MD PA Integrated Medicine & AestheticsAMIR SALIM MD PA Integrated Medicine & AestheticsAMIR SALIM MD PA Integrated Medicine & Aesthetics

Home
Services
About Us
FORMS & INSTRUCTIONS
SUPPLEMENTS
Contact Us
TELEMEDICINE

forms to download and complete prior to your appointment

Patient Registration Form (doc)Download

Assignment and Release Form (doc)Download

HIPAA Privacy Notice Form (doc)Download

Acknowledgement of Privacy Notice Form (doc)Download

HIPAA Confidential Communication Request Form (doc)Download

Release of Medical Information Form (doc)Download

Adult Medical History (pdf)Download

Pediatrics Medical History (pdf)Download

MISCELLANEOUS forms AND INSTRUCTIONS

BioTE Female Health Assessment Form (pdf)Download

BioTE Male Health Assessment Form (pdf)Download

BioTE Female Post Pellet Instructions (pdf)Download

BioTE Male Post Pellet Instructions (pdf)Download

Botulinum Toxin Instructions (before and after injection) (pdf)Download

Dermal FIller Instructions (before and after injection) (pdf)Download

ADHD Questionnaire for Adults (pdf)Download

ADHD Questionnaire for Children (Initial Visit) (pdf)Download

ADHD Questionnaire for Children (Follow Up Visit) (pdf)Download

PHQ9 Depression Questionnaire (pdf)Download

HAM-A Anxiety Questionnaire (pdf)Download

Mood Disorder Questionnaire (pdf)Download

AMIR SALIM MD PA

450 N. Texas Avenue, Suite C Webster, TX 77598, USA

Phone (281) 557-0707; Fax (281) 557-3670

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