Sexual Health Education & Economic Telehealth Services

Oct 19, 2018
Pelvic Health

Client Medical Intake Form

Overview of our Comprehensive Client Medical Intake Form

Welcome to, where we provide Sexual Health Education & Economic Telehealth Services. As part of our commitment to providing you with the highest quality care, we require all new clients to complete our detailed Medical Intake Form. This form allows us to gather essential information about your medical history, lifestyle, and healthcare goals to better tailor our services to your needs. By completing this form, you are enabling our team of experts to deliver personalized and effective care.

Why is the Client Medical Intake Form important?

At, we understand that every individual has unique medical needs. Our comprehensive Client Medical Intake Form acts as the foundation for establishing a thorough understanding of your health profile. By gathering detailed information about your medical history, current medications, lifestyle habits, and specific concerns, our experienced healthcare professionals can develop a personalized treatment plan that addresses your needs effectively.

What information does the Client Medical Intake Form cover?

When you complete our Client Medical Intake Form, we collect information across various key areas:

  1. Personal Information: We gather basic personal details such as your name, age, contact information, and preferred communication method to ensure smooth coordination of our services.
  2. Medical History: It is crucial for us to have a comprehensive understanding of your medical history, including any pre-existing conditions, previous surgeries, allergies, and current medications.
  3. Lifestyle Habits: Your lifestyle choices play a significant role in your overall health. We ask questions related to your diet, exercise routine, smoking, alcohol consumption, and stress levels to gauge any potential impact on your health outcomes.
  4. Goals and Concerns: We encourage you to share your primary health concerns, goals, and any specific symptoms you may be experiencing. This helps our team in formulating a customized treatment plan that effectively addresses your individual needs.
  5. Referrals and Previous Treatment: If you have been referred to us by another healthcare professional or have received treatment elsewhere, we appreciate knowing the details to ensure seamless coordination and continuity of care.

Our Commitment to Privacy and Data Security

At, we value your privacy and take data security seriously. Your personal and medical information submitted through our Client Medical Intake Form is treated with strict confidentiality. We adhere to stringent privacy measures and comply with all applicable healthcare data protection regulations to ensure the security and integrity of your information.

Get Started with our Client Medical Intake Form

Completing our Client Medical Intake Form is a crucial step for new clients seeking our Sexual Health Education & Economic Telehealth Services. We encourage you to provide as much detail as possible to give our experts the necessary information to create an effective treatment plan.

To access our Client Medical Intake Form, please visit Be sure to set aside enough time to complete the form thoroughly and accurately. If you have any questions or need assistance, our friendly team is here to support you.

Thank you for choosing as your trusted Sexual Health Education & Economic Telehealth Services provider. We look forward to helping you achieve optimal health and well-being!

Dena Richardson
Important form for new clients! 👩‍⚕️💼
Oct 10, 2023