PATIENT FORM

Reverse Age Medical is a licensed non-diagnostic preventative health care provider. Our doctors and medical staff directly prescribe all required tests and review and confirm all test results. We may also require/perform physical exams, consult with primary physicians, and validate and verify submitted medical information. Patients who are found to have issues and symptoms of a legitimate medical and/or health condition are referred to a medical specialist in the specific required field for diagnosis and treatment in a specialized and monitored program. Reverse Age Medical reserves the right to recommend and use internal and/or external medical specialists for any patient. All patient information will be protected under governing HIPPA rules and regulations. Reverse Age Medical is not an internet pharmacy and does not dispense, ship, or distribute medications from our facility or website. Any and all medication prescribed by our doctors and/or associated medical will be dispensed from a US FDA-approved pharmacy. All patients are required to fulfill and follow all of the medical instructions and procedures prescribed by doctors and contact us immediately if they have any problems. Patients who are found to have submitted fraudulent information will be terminated from any health program offered by Reverse Age Medical. Any medication prescribed is only for the use of the patient and is not to be transferred, distributed, modified, or used by any other person(s). Reverse Age Medical Company Inc complies with HIPAA and wants to exchange text messages with you. By clicking Submit below, you agree to receive text messages from Reverse Age Medical Company. These text messages may contain details about your care providers, programs, healthcare reminders, or conditions (e.g. low testosterone, vitamin D deficiency, low blood sugar, etc.). You acknowledge and agree that text messages are never completely private or secure. You understand text messages will be sent unencrypted and may be read or intercepted by others.