Him and Hair (Men and Women's Wellness)
  • Home
  • WEIGHT LOSS SOLUTIONS
  • HAIR LOSS SOLUTIONS
  • Red Light Therapy
  • MEN'S HEALTH
  • APPOINTMENTS
  • PRICING
  • Medical History Form
  • CONTACT US
  • ELIGIBLE STATES
  • REFUND POLICY
  • HIM AND HAIR BLOG
  • FAQ
  • Affiliated Pharmacies
  • WebinarLink
  • Online Store
  • More
    • Home
    • WEIGHT LOSS SOLUTIONS
    • HAIR LOSS SOLUTIONS
    • Red Light Therapy
    • MEN'S HEALTH
    • APPOINTMENTS
    • PRICING
    • Medical History Form
    • CONTACT US
    • ELIGIBLE STATES
    • REFUND POLICY
    • HIM AND HAIR BLOG
    • FAQ
    • Affiliated Pharmacies
    • WebinarLink
    • Online Store
Him and Hair (Men and Women's Wellness)
  • Home
  • WEIGHT LOSS SOLUTIONS
  • HAIR LOSS SOLUTIONS
  • Red Light Therapy
  • MEN'S HEALTH
  • APPOINTMENTS
  • PRICING
  • Medical History Form
  • CONTACT US
  • ELIGIBLE STATES
  • REFUND POLICY
  • HIM AND HAIR BLOG
  • FAQ
  • Affiliated Pharmacies
  • WebinarLink
  • Online Store

PLEASE USE THE FOLLOWING LINK TO FILL OUT THE INTAKE FORMS.

closeup shot of a notepad in the hand of a doctor

NEW PATIENT HISTORY FORM

 https://app.formdr.com/practice/MzA1OTQ=/form/4_1odmRFgcMuXZACbQ5LXdF2kgrN3IIF

Please Fill Out Medical History (HIPAA COMPLIANT)

Zero(0%) Percent Financing Available

Copyright © 2025 Him and Hair - All Rights Reserved.

14811 W Bell Rd/Suite 100 Surprise, AZ 85374

Powered by

  • Home
  • CONTACT US
  • PRIVACY POLICY
  • NOTICE OF PRIVACY
  • TERMS OF USE
  • MEMBERSHIPTERMSCONDITIONS
  • FLORIDA WEIGHT LOSS BOR
  • ELIGIBLE STATES
  • REFUND POLICY

This website uses cookies.

We use cookies to analyze website traffic and optimize your website experience. By accepting our use of cookies, your data will be aggregated with all other user data.

Accept