Forms

For all patients

We request that you fill out and fax the payment form to 213-402-2809, so that we may order your medications. You may also scan/email to info@pacificmd.com. Please download, print and bring the rest of the forms to your office appointment with Dr. Kim; doing so will help ensure that Dr. Kim will have sufficient time with you during your consultation.

Registration Form
General Health Questionnaire
Payment Form
Privacy Practices
Privacy Practices Notice

For Testosterone Patients

If you are going to receive testosterone treatment, then please fill out and bring these forms as well:

Consent for Testosterone Replacement Therapy
Pacific Longevity Supplement Guide

For Hypothyroid, Female Hormone and Adrenal Fatigue Patients

If you are to receive treatment for hypothyroidism and/or adrenal fatigue, please fill out and bring these forms to your appointment as well:

Hypothyroidism Symptoms Checklist
Consent for Hormone Replacement Therapy
Adrenal Fatigue Questionnaire
Thyroid Adrenal Menopause – Supplement Guide