Senara provides copies of our intake form(s) online for new Anti-Aging and Functional Medicine care guests. Available as downloadable PDFs, you may fill out your intake form at your convenience before your first visit with us.
For all Anti-Aging and Functional Medicine patients we request that these forms be completed and sent to us no later than 24 hours prior to your scheduled appointment. This will allow your Senara Doctor time to review the information thoroughly and prepare for your visit.
If you have not scheduled your initial appointment yet, please call 309.285.8979 prior to filling out the form.
New Anti-Aging Medicine Guests Printable Forms
To download and print your intake form, please follow these steps:
- If AdobeReader® is not yet installed on your computer, download it first.
- Using AdobeReader or AdobeAcrobat, you can download forms, print them out and fill-in the required information.
- Forms you can download include:
Medical Forms & Records
Anti-Aging Medicine guests must complete and submit their Medical History Form and copies of any laboratory tests and diagnostics from other medical providers to us no later than 24 hours prior to their initial scheduled appointment. If you are unable to submit this information to us within the requested time frame we will reschedule your appointment to a later date.
If you have medical records that are pertinent to your initial visit or follow-up visits, you are responsible for obtaining them prior to that appointment. Your Medical Records can only be authorized for release by you. Please contact your physician or other health care provider to order these records.
All Medical Forms and Records should be submitted to us via one of the following options:
- Fax: 309.693.3616
- Mail: Attn: Dr Keith Kramer, 2208 W Willow Knolls Rd, Peoria, IL 61614
- E-mail: email@example.com
- Drop off to the front desk staff at Senara