Patient History and Information

We very much look forward to hearing from you and expect that your travels to Beverly Hills will be the most fruitful, allowing for wonderful transformation of both your body and your spirits.


Follow these steps to successfully submit your Patient Forms.


1. Download and fill up the appropriate form below.

Click here to download the Female Patient Form.

Click here to download the Male Patient Form.

(You may type in text directly on the form and save the file. The form is best edited on Google Chrome or Microsoft Edge browsers.)

Note: You can affix your signature on a later date at our office.

2. Upload the accomplished form with your e-mail address below.