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:

Email us your completed forms, or, you can print and send your forms to us at this mailing address.

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:
  • Drop off to the front desk staff at Senara

*These statements have not been evaluated by the Food and Drug Administration. This information is for educational purposes only and is not intended to diagnose, treat, prevent or cure any disease.  These products and services are intended to support, not replace, your current medical care. Individual result may vary.