Forms

Provide information so we can help you.

Required Intake Form 1

Contact & Health History Information Form

This form is used to provide your contact information and a thorough health history.

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Required Intake Form 2

HIPAA Notice of Privacy Practices

This form is used to provide you information regarding privacy practices.

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Required Intake Form 3

Acknowledgement & Consent Form

This form is used to confirm your acknowledgement of RED Zone Health & Wellness, LLC practices and your consent regarding products, care, and services.

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Established Patient on Medication

Please use this form if you are an established patient receiving weight loss injections from another provider, and wish to transition to RED Zone.

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Follow Up Contact Form

Please use this form for follow-up reporting and prescription refill requests.

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Daily Intake and Activity Form

Keep track and report your daily intake and activities.

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Need assistance?

Forms

Contact & Health History Information Form

HIPAA Notice of Privacy Practices

Acknowledgement & Consent Form

Established Patient on Medication

Follow Up Contact Form

Daily Intake and Activity Form

Our team is happy to walk you through the process.