Patient Consents & Forms
Welcome. Below are reference copies of all consent forms used at Navara Health. These are intended to help you review what you will be agreeing to before your visit. The specific consents that apply to your appointment will be sent to you electronically for signature as part of your intake.
You are welcome to read, save, print, or share these with family members or other providers. If you have questions about any consent, please contact us before signing.
Book Your Visit
Schedule your appointment online, by phone, or by email. We will send your intake forms shortly after.
Review & Sign
You will receive the consents specific to your booked service. Review carefully, ask questions, and sign electronically before or at your visit.
Visit & Care
Your signed consents become part of your permanent medical record. We will review them with you at any time during your care.
Intake & Practice Policies 5 documents
Required for all new Navara Health patients
General Consent & Practice Policies →
Treatment, communication, and general practice acknowledgment
Notice of Privacy Practices →
Your HIPAA privacy rights and our use of your information
NPP Acknowledgment →
Signed acknowledgment of receipt of Notice of Privacy Practices
Payment & Cancellation Policy →
Self-pay terms, cancellation fees, refund policy, card on file
Off-Label Medication Consent →
Umbrella consent for off-label prescribing
Telehealth & Identity 2 documents
Required for telehealth visits (TX, CO, CT, FL, IA, OK, VT, VA, WA)
Telemedicine Consent →
Telehealth platform, technology, state authorization
ID Verification Consent →
Identity verification requirements for telehealth
Hormone Optimization 4 documents
Required for HRT, TRT, BHRT, and testosterone optimization patients
HRT Membership Consent →
Membership terms for ongoing hormone optimization care
Men's TRT Clinical Consent →
Risks, benefits, monitoring protocol for testosterone therapy in men
Women's BHRT Clinical Consent →
Bioidentical hormone therapy for perimenopause/menopause
Testosterone Controlled Substance Agreement →
Schedule III testosterone prescribing agreement
Metabolic, Peptide & IV Therapy 5 documents
Required for GLP-1, peptide, IV/IM injection, and NAD+ patients
GLP-1 Therapy Consent →
Semaglutide, tirzepatide, retatrutide (compounded & commercial)
Peptide Therapy Consent →
General peptide therapy protocol and risks
IV Infusion & Injection Consent →
General IV/IM therapy consent
NAD+ Infusion Consent →
NAD+ IV-specific consent and risks
Compounding Pharmacy Authorization →
Authorization for compounded preparations
Aesthetic Services 5 documents
Required for tox, filler, PRP, VAMP™, and general aesthetic patients
General Aesthetic Procedure Consent →
General aesthetic procedure consent
Neurotoxin & Dermal Filler Consent →
Botox, Dysport, Xeomin, hyaluronic acid fillers
Kenalog (Intralesional) Acne Consent →
Triamcinolone injection for acne
PRP Injection Treatment Consent →
General PRP for face, joint, hair, scar, stretch marks
VAMP™ (PDRN) Consent →
Prollenium PDRN topical therapy
Vampire® Procedures (CMA-Certified) 4 documents
Performed exclusively by Jessica Boggs, APRN (CMA-certified)
Vampire Facial® Consent →
CMA-trademarked microneedling with PRP
Vampire Hair Restoration® Consent →
CMA-trademarked scalp PRP for hair restoration
O-Shot® / Orgasm Shot® Consent →
CMA-trademarked female sexual wellness PRP procedure
P-Shot® & P-100 Shot™ Consent →
CMA-trademarked male sexual wellness PRP (P-Shot) and enhanced protocol with intracavernosal Botox (P-100)
Other Clinical Services 2 documents
As applicable to your visit
Direct Primary Care (DPC) Membership →
DPC membership terms and enrollment
Supplement Recommendation Consent →
Acknowledgment of supplement recommendations
Privacy, Records & Media 2 documents
Privacy, records release, and media use authorizations
PHI Release Authorization →
Authorization to release medical records to specified parties
Photography, Video & Marketing Consent →
Optional consent for photo and video use
Insurance & Federal Payer 1 document
Required for Medicare, Medicaid, TRICARE beneficiaries
Questions Before Signing?
If you have questions about any consent, want to discuss before your appointment, or need any of these documents in another format, please reach out. Our team is happy to walk through any document with you.
Dallas, TX 75240
These are reference copies. Signed copies become part of your permanent medical record.