Patient Information

Patient Information
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Intake Forms:

Pain and Inflammation Patient Intake Form

Erectile Dysfunction Intake Form

Low Testosterone Intake Form

Hair Loss Patient Intake Form

Peyronie's Disease Intake Form

RejuvaMAX Enhancement Intake Form
New Patients
We must first collect information on your medical history and current condition before starting the treatment process.
This information allows us to customize your treatment plan accordingly. You can fill out this information in a “New Patient Information Form” before your appointment. Do not hesitate to restore your sexual spontaneity, youthful vigor, and vitality. Call us at 561-232-3704 today to learn more about our services or schedule an appointment.
Payment Methods – Check or Cash Accepted

Payment Methods – Check or Cash Accepted

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Intake Forms:

New Patients

Payment Methods – Check or Cash Accepted

Payment Methods – Check or Cash Accepted

Your Boca Raton Sexual Health and Male Rejuvenation Physician

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