Before your first appointment for Hormone Restorative Therapy our office must have the following documentation on file. If all the documentation is not on file our doctor cannot see you for Hormone Restorative Therapy – no exceptions.
Required documentation for Women:
- 1. Current Mammogram report. This report must be dated less than ONE YEAR prior to your initial appointment.
- 2. Current Pap Smear report. This report must be dated less than ONE YEAR prior to your initial appointment unless GYN documentation supporting an alternative schedule
- 3. Results of your Saliva Test. Stop by our office to purchase a saliva kit that you will mail to the lab indicated on the box. The kit must be mailed to the lab not less than 2 weeks before your appointment. You will not need an appointment to purchase your saliva kit. The cost of the saliva kit is $160.00. That includes the cost of the kit, postage and the results which will be sent to our office.
Required documentation for Men:
- 1. An annual physical exam dated less than ONE year prior to your initial appointment.
- 2. Current PSA results with results dated less than ONE year prior to your initial appointment. If you do not have a current PSA results you can make an appointment with our office to have your blood drawn. In order to get your results back and for our doctor to review your PSA results please schedule your blood test two weeks before your hormone appointment. You WILL need an appointment to have your blood drawn in our office. The cost of the PSA test will be $45.00
- 3. Results of your Saliva Test Stop by our office to purchase a saliva kit that you will mail to the lab indicated on the box. The kit must be mailed to the lab not less than 2 weeks before your appointment. You will not need an appointment to purchase your saliva kit. The cost of the saliva kit is $160.00. That includes the cost of the kit, postage and the results which will be sent to our office.
We do not perform or request mammograms, pap smears or men’s exams at this office.
Please see your primary care physician to schedule these tests.
Office Visits: You will be asked to return monthly so that adjustments may be made to the dosage of the hormones and/or supplements. Once your hormones have stabilized, you will be required to return to our office in six months for a re-check. On your six month visit it will be necessary to measure your hormone levels by repeating the saliva test so that you will be able to continue therapy.
If you are a weight control and hormone patient your appointments can be combined.
Prescriptions: Hormone therapy prescriptions will be written to provide enough refills to last until your next scheduled office visit. Most prescriptions will be for compounded hormones that will need to be filled at a pharmacy that compounds medication. We can provide you with a list of local pharmacies who compound medications.
REMINDER: We do not accept checks in our office. We do accept credit cards, debit, or cash. We do not file insurance or complete insurance forms for any of our services. Payment to our office is due, in full, the day of service. If you do have insurance that pays for our services you can submit your bill to them for reimbursement.
Charges for Existing Weight Control Patients who wish to add Hormone Restorative Therapy
Charges for patients wanting Hormone Restorative Therapy only
ALL CHARGES ARE DUE AT TIME OF SERVICE and YOU MUST HAVE AN APPOINTMENT FOR ALL SERVICES (with the exception of picking up your saliva kit)
Your compounded hormones will be an additional cost to you and the cost can vary by the pharmacy. We recommend Ray’s Pharmacy but you are not obligated to take your prescription there.
Ray’s Pharmacy Town North Ray’s Pharmacy Mansfield
975 N. Cooper St. – Arlington, Texas 76011 1831 E. Broad Street – Mansfield, Texas 76063 Phone: (817) 274-8221 Phone: (817) 473-1145
Hours: 9:00 a.m. – 6:00 p.m. Hours: 9:00 a.m. – 7:00 p.m.
Saturday: 9:00 a.m. – 2:00 p.m. Saturday: 9:00 a.m. – 2:00 p.m.
Reminder, NO INSURANCE is accepted and we do not fill out insurance forms. If you have insurance that will cover these services you must submit all necessary forms to your insurance company for reimbursement. We accept cash, debit or credit cards. NO CHECKS
REQUIRED LAB RESULTS
If you would like to bring current lab work from another doctor the results must contain the following with
no exceptions. All results must be dated less than six months prior to your initial appointment.
We will need these results two weeks before your hormone appointment so our doctor can review them.
Required Test Results for Women Required Test Results for Men
FSH Testosterone
TSH Estradiol
Estradiol FSH
Testosterone LH
Free and Total with SHBG Free T3
uE3 Free T4
LH SHBG
Progesterone PSA
Free T3 TSH
Free T4 Lipid Panel
DHEA non-sulfate CMP
Estrone (E1) CBC
Estriol
Lipid Panel
CMP
CBC
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