• This form and the appointment calendars are uber complex! If changes are needed, let Lark know. Thanks :D

  • **STOP**STOP**STOP**STOP**STOP**STOP**

    Use this form for CURRENT clients who want to schedule a followup appointment ONLY.

    DO NOT USE FOR NEW CLIENTS - they need to fill out the online form. 

    I've had way too many no-call/no-shows for "new clients" at the register.  

    There is a $65 fee for no-shows - information is on the first and last page of online form

  • PATIENT CONSULTATION FORM

    PATIENT CONSULTATION FORM

    All in-person 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 or Zoom consultation: 
        • Please make sure to attach your labs with the link at the end 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 week-day prior to your appointment. 
        • The number to call for phone appointments is 214-349-8000, ext 0.
        • For Zoom appointments, we will send a link a day or two before your appointment.
      • Payment:
        • Payment is expected at the time of service.  If you have a phone or Zoom call, we will collect your payment information at the end of our time together.
      • Cancellations, Rescheduling and No-Show:
        • If you need to cancel or change your appointment time, please let us know at least 24 hours before your appointment time so we can contact clients on our wait list and to avoid a $65 cancellation fee.
        • If you have an illness or emergency you need to attend to, please give us a call as soon as possible and we'll be happy to reschedule your appointment.
      • 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

    and to avoid a No-Show fee

     

    We're looking forward to meeting with you!

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  • Tell Me About Yourself

  • Diet and Lifestyle Information

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

  • Do you skip meals?            *                   
    Do you eat organically?         *               
    How often do you eat at restaurants or get takeaway?         *      
    When you go out, what are your favorite restaurants?   *

  • How much water do you drink per day?   *   
    How many cups/glasses of coffee/tea do you drink per day? *   
    How many sodas/energy drinks do you drink per day?    *         
    How many alcoholic beverages do you drink per week?            *      

  • What is your smoking status?            *      
    Do you consume chemical sweeteners?            *      
    Do you consume natural sweeteners?            *             

  • Do you find that you get colds, the flu (or Covid) often?      *         
    Do you feel you are digesting your food properly?      *      
    Do you feel bloated/gassy after you eat?      *    
    How are your bowel habits                 

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  • Allergy, Medication and History Information

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