Patient Intake Forms | Lavena Health
Physician-Led · Temple Terrace, FL

Start Your Health Journey. Patient Intake Forms.

Select your program below and complete your intake online. Every submission is personally reviewed by a board-certified physician, and you'll hear back within 1–2 business days.

Board-Certified Physicians
HIPAA Secure
1–2 Day Response
No Insurance Required

Choose Your Intake Form

Each form takes 8–12 minutes on any device. Your responses are encrypted and reviewed only by your physician.

General Wellness

New Patient General Intake

Not sure which program is right for you? Complete a general intake and your physician will recommend the best plan.

  • General health history
  • Symptom & goal review
  • Provider recommendation
  • No commitment required
~8 minutes
Start Intake
Medical Weight Loss

GLP-1 Weight Loss Program

Physician-supervised semaglutide, tirzepatide, or retatrutide therapy — personalized dosing and direct-pay transparency.

  • Semaglutide, tirzepatide & retatrutide
  • Weight history & goals assessment
  • Full medical screening
  • Informed consent & e-signature
~10 minutes
Start Intake
Men's Health

TRT & Men's Hormone Therapy

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
~10 minutes
Start Intake
Women's Health

Women's Hormone Replacement

Estrogen, progesterone, and testosterone optimization for perimenopause, menopause, and hormonal imbalance.

  • Full symptom severity assessment
  • Complete gynecologic history
  • Hormone lab value intake
  • Informed consent & e-signature
~12 minutes
Start Intake
Sexual Health

Sexual Health & Libido

Generic Viagra, generic Cialis, PT-141, and hormone precursors (pregnenolone, DHEA). Physician-supervised care for ED, low libido, and arousal concerns — men and women.

  • Sildenafil & tadalafil (generic Viagra/Cialis)
  • PT-141 / bremelanotide for arousal
  • Pregnenolone & DHEA precursors
  • Cardiovascular & medication safety screen
~10 minutes
Start Intake
Advanced Therapy

Peptide Therapy

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
~10 minutes
Start Intake
Longevity Medicine

NAD+ & Longevity Therapy

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
~10 minutes
Start Intake

Direct-Pay Care, Done Right

No insurance middlemen, no inflated pricing, no gatekeeping. Just thoughtful medicine and time with your physician.

No insurance — transparent pricing
Fast, direct access to physicians
Personalized treatment plans
Walk-ins welcome
In-person & telehealth visits
1–2 day response on all intakes

How It Works

From intake to prescription — a simple, physician-led process.

1

Choose Your Program

Select the intake form that matches your treatment goal.

2

Complete Your Intake

Answer questions about your health, symptoms, and goals in 8–12 minutes.

3

Physician Review

A Lavena physician personally reviews your intake within 1–2 business days.

4

Start Your Protocol

We contact you to discuss your plan, any needed labs, and transparent pricing.

Visit Us in Temple Terrace

Same-day and walk-in visits available. Telehealth throughout Florida.

Address
5340 E 131st Ave, Suite 106
Temple Terrace, FL 33617
Hours
Mon–Fri · 9:00 AM – 5:00 PM

Ready to Begin?

Book directly, or start your intake form and our team will reach out to schedule your consult.

Book Appointment Start Intake Form

Frequently Asked

Is the intake form HIPAA secure?

Yes. All intake forms transmit over encrypted connections and your information is only accessible to your Lavena Health physician.

How long does the form take?

Most forms take 8–12 minutes on any device — phone, tablet, or computer. You can save and return if needed.

Do I need insurance?

No. Lavena Health is a direct-pay clinic. Your physician will discuss transparent pricing before any prescription is issued.

What happens after I submit?

A physician personally reviews your intake and contacts you within 1–2 business days by phone or email.

Do I need labs before submitting?

No. If bloodwork is required, we'll send you a lab requisition after reviewing your intake.

Can I use telehealth from anywhere?

Telehealth is available to patients throughout Florida. Walk-ins are welcome at our Temple Terrace location.

Doctors Lavena Health Temple Terrace

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