• PLEASE!!!! Be careful when editing!!!! This form and the appointment calendars are complex! PLEASE do not duplicate fields as I've had patients schedule with me on the "extra" calendar for days that I'm not available. PLEASE, if you need to make changes, check with Lark first. Thanks :D

  • PATIENT CONSULTATION FORM

    All consultations take place in our Dallas location: 8220 Abrams Rd, Dallas, TX 75231. 214-349-8000

  • Welcome to Abrams Royal Pharmacy! We are so happy that you have chosen us to help guide you on your health care journey. Our goal is to provide you with accurate and up to date information to help you make informed choices regarding your health.

    If you're already established as a client and have had a consultation within the past year, simply choose "Current Client", fill in your information, choose a date and time, and we're all set.  If this is your first consultation, or its been over a year since we've met, please choose "New Client" and fill out the online form in its entirety.  

     In order to make the most of our time together, we respectfully request the following: 

      • We will NOT look at your labs and/or documents on your phone or personal device.
        • We cannont analyze your labs on your phone. Please attach these with the link at the bottom of the intake form. 
        • If you are unable to attach your documents, print out copies ahead of time and bring them with you. 
      • Bring in all current prescriptions and supplements you are taking . 
        • I understand that for some people, this may mean lugging in a big bag of bottles, and that’s ok – we don’t scare that easily😊.  
        • If you are taking supplements or prescriptions that requires refrigeration, go ahead and leave those at home. Just make sure to jot down the name, brand and dose on your intake form.

      • Please, please please!! DO NOT wear perfume, cologne or essential oils!

        • These are migraine triggers for several of our employees and customers and we 

          absolutely reserve the right to reschedule your appointment without refund if we believe our health or or that of our sensitive clientelle is being compromised.
      • If you have a phone consultation:  
        • Please make sure to attach your labs with the link at the bottom of the intake form.  If you are unable to attach your forms, you may email  or fax them to 214-341-7966  at least 1 day prior to your appointment.  
        • The number to call for your appointment is 214-349-8000, ext 0. If we do not have your payment information on file, we will ask for it at this time.
      • You are more than welcome to bring a family member or friend with you if you feel it would be beneficial.  

     

    If you are unable to make your appointment, please call the pharmacy

    at least 24 hours in advance so we may contact clients on our wait list.  

     

    We're looking forward to meeting with you!

  • Use this form for clients who want to schedule a followup appointment while at the register. Do not use for new clients - they need to fill out the online form.  

    Clients will receive an immediate email appointment confirmation and another email 2 days before their appointment. 

     

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  • Tell Me About Yourself

  • Diet and Lifestyle Information

  • How many days per week do you exercise?   *   What type of exercise?   *   

    Have you had the usual childhood vaccines?        *         

    Do you get the flu shot every year?             *                      

    Have you had one of the Covid-19 vaccines?              *          

    How regularly do you skip meals?              *         

    Do you eat organically?            *

    How often do you eat at restaurants or get takeout?              *        

    When eating out, what are your favorite restaurants?     *   

    Do you consume sodas/sports drinks/flavored water?            *             

    How many alcoholic beverages do you drink per week?                  *                               

    How much water do you drink per day?    *   

    How many cups/glasses of coffee/tea do you drink per day?             *               

    Do you consume chemical sweeteners, if yes which ones?                *       
                         
    Do you consume natural sweeteners, if yes which ones?               *       

    What is your tobacco/vape use?             *      

                      

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  • Allergy, Medication and History Information

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