AMIR SALIM MD PA

Integrated Medicine
&
Aesthetics

(281) 557-0707

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

AMIR SALIM MD PA

Integrated Medicine
&
Aesthetics

(281) 557-0707

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

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 Male and Female Health Assessment (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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