Start Your Health Journey.
Patient Intake Forms
Select your program below and complete your intake form online. Our physicians personally review every submission and contact you within 1–2 business days.
View Intake FormsOur Services — Intake Forms
Choose the program that matches your health goal. Each form takes 8–12 minutes to complete on any device.
Physician-supervised semaglutide or tirzepatide therapy. Personalized dosing and real results — no insurance required.
- Semaglutide & tirzepatide options
- Weight history & goal assessment
- Full medical screening
- Informed consent & e-signature
Testosterone replacement and men's hormone optimization. Restore energy, strength, libido, and mental clarity.
- Full symptom severity assessment
- Fertility & reproductive history
- Prior TRT & lab value intake
- Informed consent & e-signature
Estrogen, progesterone, and testosterone optimization for perimenopause, menopause, and hormonal imbalance.
- Full symptom severity assessment
- Complete gynecological history
- Hormone lab value intake
- Informed consent & e-signature
BPC-157, CJC-1295, Ipamorelin, PT-141, and more. Recovery, anti-aging, performance, and cognitive enhancement.
- Full medical & allergy history
- Prior peptide use assessment
- Treatment goals & lifestyle
- Informed consent & e-signature
Focus on long-term health, prevention, and performance. Personalized care to help you live healthier, longer.
- Comprehensive health history
- Energy & metabolic assessment
- Longevity goals evaluation
- Informed consent & e-signature
Not sure which program is right for you? Complete a general intake and our physician will recommend the best plan.
- General health history
- Symptom & goal review
- Provider recommendation
- No commitment required
Why Lavena Health?
How It Works
From intake to prescription — a simple, physician-led process.
Choose Your Program
Select the intake form that matches your treatment goal above
Complete Your Intake
Answer questions about your health, symptoms, and goals in 8–12 minutes
Physician Review
A Lavena Health physician personally reviews your intake within 1–2 business days
Start Your Protocol
We contact you to discuss your personalized plan, any labs needed, and pricing
Contact Us
5340 E 131st Ave Suite 106, Temple Terrace, FL 33617
Phone: (813) 805-8917
Email: [email protected]
Same-day and walk-in visits available
Book AppointmentFrequently Asked Questions
Yes. All intake forms use encrypted transmission and your information is only accessible to your Lavena Health physician.
Most forms take 8–12 minutes on any device — phone, tablet, or computer.
No. Lavena Health is a direct-pay clinic. Your provider will discuss transparent pricing before any prescription is issued.
A physician personally reviews your intake and contacts you within 1–2 business days by phone or email.
No. If bloodwork is required we will send you a lab requisition after reviewing your intake.
Yes. We offer telehealth to patients throughout Florida. Walk-ins are welcome at our Temple Terrace location.
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