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Consultation Request

Tell us the outline. Keep the details for the room.

What you are interested in, what you have had done before, and when you are free. That is all this form is for. Your medical history is taken in the clinic, in a system built to hold it. Never here.

Alder · Request a consultation

Please do not send health information through this form

Web forms send email. Email is not a secure medical record, and a website is not the right place for your conditions, medications, allergies, or pregnancy status. None of that is asked below, and we would ask you not to volunteer it.

Full medical history and contraindication screening are taken at the consultation, on our device, in the practice's own compliant charting system, where the record is protected, auditable, and actually usable by the practitioner treating you.

i · Who you are

ii · What you would like to talk about

If nothing here fits, leave it blank. “I do not know what I want, only that something feels off” is a completely normal way to arrive.

Asked for scheduling only. Intervals between injectable appointments matter, and it changes which day we offer you. The clinical detail is taken in the room.

iii · Timing

Optional. If there is a wedding or a trip, say so. Plans get built backwards from the date.

Free text is optional. It is read by the practice, not by an assistant, and it is not stored as a medical record.

Request received. On the live site this lands in the practice inbox straight away. The practice replies with two or three times, usually within four business hours, and always with a person's name on the message. Nothing is confirmed until you reply.
One more thing

This inbox is not for urgent concerns.

The request form is checked during opening hours only. It is not monitored overnight, on Sundays, or on Mondays when the practice is closed.

If you are having a medical emergency, call 911. If you have a concern about a treatment you have already had here (anything unexpected, anything that is not settling the way it was described to you), call the practice directly on 720.555.0177 rather than sending a form. Post-treatment calls are put through to the practitioner, not to a queue.

General questions about what a treatment involves are answered in the field notes, and the service menu carries current pricing for everything on offer.