RESTORE. RENEW. REVITALIZE!
  • Home
  • Weight Loss Solutions
    • HCG Weight Loss Plan >
      • What To Expect
    • Metabolic Testing >
      • What To Expect
    • Ultimate Weight Loss System >
      • Ingredient list and information packet
    • Lipotropic Injections
    • Pricing
  • Hormone Therapy
    • Take The Hormone Test!
    • Bio-Identical Hormone Therapy >
      • What To Expect
    • Sermorelin Therapy >
      • What To Expect
    • Pricing
  • Platelet-Rich Plasma Therapy
    • Facial and Facelift
    • Hair Regrowth
    • Scar Repair
    • Breast Lift and Buttocks Lift
    • Female Enhancement
    • Male Enhancement
    • Pricing
  • About Us
  • New Patients
    • Office Policies
    • Forms
    • Payment Options
  • Referral Program
  • Products
  • Patient Satisfaction
  • Before and After Photos
  • Contact

For your convenience, we have provided downloadable copies of the New Patient Forms at the links below. Please print and fill out the forms below that may apply to you.

New Patient Registration Form

IPL New Patient Registration Form

IPL Consent Form

Your privacy is important to us. Please review our Notice of Privacy Practices below.

notice_of_privacy_practices.pdf
File Size: 190 kb
File Type: pdf
Download File

ProGenix Health Solutions, Inc. 
Wilson: 2519 Airport Blvd NW Suite E Wilson, North Carolina 27896
Greenville: 1609 W. Arlington Blvd. Suite 100 Greenville, NC 27834 

© 2012 Serving Eastern North Carolina
, Raleigh, Durham, Goldsboro, Rocky Mount, Greenville
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