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10887 North Military Trail, Suite 7 Palm Beach Gardens, FL 33410
(561) 537-0537 | Gift Cards Available!
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Youthful Balance Medical Center in Palm Beach Gardens
  • Home
  • About
    • Our Staff
    • Patient Forms
    • Blog
      • The Palm Beach Golfcast
  • Services
    • PDO Threading
    • PRP
    • Cosmetics
      • Botox Treatment
      • Juvederm Treatment
      • Xeomin
      • RADIESSE®
      • Hair Loss
      • VI Peel Chemical Peels
        • VI Derm Products
      • Lash Enhancer
      • Micro-Needling
      • Double Chin Treatment – Kybella
    • Hormone Replacement Therapy
      • Men’s Hormones
      • Women’s Hormones
    • Weight Loss
      • Semaglutide
      • Ideal Protein Diet
      • AOD 9604
      • Success Stories
    • Vaginal Rejuvenation
      • The O-Shot
    • Erectile Dysfunction
    • Hair Removal
  • Nutrition
    • Supplements
    • FIT Test
    • Intravenous (IV) Vitamin Therapy
    • Injectable Vitamins & Amino Acids
    • Nutrient Testing
    • NAD Therapy
  • Peptides
  • Success Stories
    • Testimonials
    • Before & Afters
  • Contact

Patient Forms

Please view & download patient forms below. Please print and fill these out prior to your visit. If you’d like to fill them out online please use a tool like https://www.pdfescape.com/, then email the form to diane@youthfulbalance.net

PLEASE CLICK THE FORM LINKS BELOW TO DOWNLOAD & VIEW

Female Patient Medical History Form

Male Patient Medical History Form

Youthful Balance Medical Center
10887 North Military Trail, Suite 7 Palm Beach Gardens, FL 33410
Phone: 561-537-0537
Hours: Monday-Friday 9am-5pm

Disclaimer: Youthful Balance can not make any guarantee of results with services like hormone therapy, weight loss and more. Each patient is different and results will vary. Although patients may receive a prescription from Youthful Balance, they will be sent to a pharmacy to fill any such order.
© 2016 Youthful Balance Medical Center, LLC.
All Rights Reserved.
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