770.649.0094
4343 Shallowford Rd #150, Marietta,GA 30062
VIRTUAL CONSULT
TEXT US
Home Page
About Dr. Kelley
Lean Body Program
Semaglutide
Wellness
Bioidentical Hormones
IV Therapy
Liquivida Drip Glossary
GI Health
Oshot l Feminine Rejuv
O Shot
Vampire winglift
V fit Gold
Procedures
Xeomin Wrinkle relaxer
Botox
Sculptra-CWA Precise Sculpt
Wrinkle Fillers- Contour and Rejuvenate
Radiesse-Contour, Lift and Tighten
Microneedling stimulates Collagen and Elastin
Exilis Elite Facial Skin Tightening
PRP Hair Therapy
Pre and Post PRP hair Instructions
PRP Injections
O Shot
Testimonials
Pricing
770.649.0094
4343 Shallowford Rd #150, Marietta,GA 30062
VIRTUAL CONSULT
TEXT US
Home Page
About Dr. Kelley
Lean Body Program
Semaglutide
Wellness
Bioidentical Hormones
IV Therapy
Liquivida Drip Glossary
GI Health
Oshot l Feminine Rejuv
O Shot
Vampire winglift
V fit Gold
Procedures
Xeomin Wrinkle relaxer
Botox
Sculptra-CWA Precise Sculpt
Wrinkle Fillers- Contour and Rejuvenate
Radiesse-Contour, Lift and Tighten
Microneedling stimulates Collagen and Elastin
Exilis Elite Facial Skin Tightening
PRP Hair Therapy
Pre and Post PRP hair Instructions
PRP Injections
O Shot
Testimonials
Pricing
Home Page
About Dr. Kelley
Lean Body Program
Semaglutide
Wellness
Bioidentical Hormones
IV Therapy
Liquivida Drip Glossary
GI Health
Oshot l Feminine Rejuv
O Shot
Vampire winglift
V fit Gold
Procedures
Xeomin Wrinkle relaxer
Botox
Sculptra-CWA Precise Sculpt
Wrinkle Fillers- Contour and Rejuvenate
Radiesse-Contour, Lift and Tighten
Microneedling stimulates Collagen and Elastin
Exilis Elite Facial Skin Tightening
PRP Hair Therapy
Pre and Post PRP hair Instructions
PRP Injections
O Shot
Testimonials
Pricing
Hormone/Wellness Female Follow Up Form
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Hormone/Wellness Female Follow Up Form
General Information
Name:
Email address. We will email you a copy of your results before your appt
How are you doing overall?
Is their something you would like to improve?
If yes, please describe
Are you taking your hormone meds as they have been prescribed?
Yes
No
If not, how are you taking your hormones?
Please tell us about any other medications (besides hormones) that you are taking.
Please list the supplements you are taking
Health Screening Questions
Last Menstrual Cycle, if you are still having periods
Last Pap smear and Pelvic Exam:
Last Breast Imaging:
Last Bone density
Last Colonoscopy:
Do you have a Primary Care doctor?
Have you had lab testing with your PCP?
Yes
No
Signs of estrogen imbalance
Please check if you are experiencing
Breast/Nipple tenderness
Moodiness
Difficulty getting rings on and off
Hot flashes
Brain fog
Vaginal dryness
Signs of progesterone imbalance
Please check if you are experiencing
Poor sleep
Morning grogginess
Anxiety
Anxiety
Signs of testosterone imbalance
Please check if you are experiencing
Low libido
Difficulty building muscle
Lack of motivation
Short tempered
Family members saying you are more irritable
Oily skin/Acne
Hair growth face or chest
Signs of thyroid imbalance
Please check if you are experiencing
Palpitations
Shortness of breath
Heart racing
Agitation
Fatigue
Dry skin
Constipation
Difficulty focusing
Weight gain
We are developing a Body Composition program. Maintenance of lean muscle is important for overall health, longevity and vitality. Would you be interested in learning more?
Yes
No
