Health Intake Form -
Please Fill This Out
Steps for your appointment in-person or Virtual visits:
Please fill out all New Patient forms in their entirety and email them back at least 72 hours before the meeting.
If you have any recent labs you are welcome to send an email to dawn@agekure.com at least 3-4 days before the meeting so we can prepare.
If you are married or in a relationship, please bring your spouse or significant other with you to your appointment. We consider the support of a partner as a very important part of success in our client’s journey and also critical to making health, lifestyle, and financial decisions.
Please arrive or log in on time. If you are late by more than 10 minutes we will reschedule you for another day.
You and the partner must be in a room with no distractions and a good Wi-Fi connection on a Laptop to have this important conversation regarding your health. We need you to check the audio and video connections on your Laptop before the meeting for any technical issues.
Kindly silence your cell phone during this time
The Agekure Team would like to provide you with an hour of undivided attention to discuss your health concerns and future health goals. Our program members later told us this was the most important discussion of their lifetime and a “ WAKE UP CALL”.
Please make sure you and your spouse or partner have watched our short video that explains our approach to health so we can spend more time talking about your health concerns.
Important Requirements for the Visit
We need you to fill out the Health History Forms ASAP after the discovery call and at least 72 hrs before the visit. If this is not done, we will reschedule your appointment
We require a 48-hour notice to reschedule your appointment. We will reschedule your appointment only once as a courtesy as we are booking an hour of our team's time as well.
There are absolutely no refunds on the payment once the appointment is scheduled.
Note: If these steps are not followed it may compromise the full value of your consultation and therefore we will kindly reschedule your appointment.
I HAVE READ AND UNDERSTAND THE MESSAGE ABOVE