Welcome to AVUM Health

Our process begins with a comprehensive health intake and bloodwork review.

After your intake is submitted, our team will review your information and help coordinate any necessary laboratory testing. Once your results are available, you'll have the opportunity to schedule a secure telehealth consultation with a licensed provider to review your biomarkers, discuss your health goals, and receive personalized recommendations.

Please complete the form as thoroughly and accurately as possible.

Comprehensive Bloodwork Review & Health Consultation

Please complete the information below so our team can prepare for your consultation and verify your patient profile.

First Name *

Last Name *

Date of birth *

Phone *

Email *

Preferred Language *

Address

Street Address

City

State

Country

Postal Code

Sex Assigned at Birth *

Height

Weight

Do you have any medical conditions we should be aware of?

Are you currently taking any medications or supplements?

Do you have any allergies?

Have you completed bloodwork within the last 12 months?

Yes

Not sure

If yes would you like to upload your labs?

Click to upload your labs

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Government-Issued Photo ID

Click to upload your ID

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 5 Files )Used to verify patient identity, ensure accurate medical records, and facilitate any future treatment recommendations or pharmacy orders if applicable.

Upload Front and Back of Health Insurance Card (optional)

Click to upload your health insurance card

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 4 Files )Upload your insurance card if you would like us to attempt to process your laboratory order through your insurance. Please note that coverage and costs vary by plan and are determined entirely by your insurance provider. AVUM Health does not control insurance pricing or coverage decisions. Affordable self-pay laboratory options are also available.

Consents & Acknowledgments

By checking this box, I consent to receive non-marketing text messages from AVUM Health regarding appointments, intake forms, laboratory orders, treatment updates, and patient care coordination. Message frequency varies. Message and data rates may apply. Reply STOP to opt out.

I understand that AVUM Health provides telehealth wellness consultation services. I certify that the information provided is accurate and complete to the best of my knowledge and understand that treatment recommendations, if appropriate, are determined after provider review and consultation.