Patient Resources & Downloads
Patient Forms
Download and complete these forms before your visit to streamline your check-in process.
Save Time at Check-in
Completing your paperwork in advance helps Dr. Islam and our staff spend more time focused on your care.
Bring completed forms to your appointment or email them to our staff.
New PatientsPDF Format
New Patient Questionnaire 2025
Required for all first-time patients. Comprehensive medical history, current medication list, and emergency contact details.
Required ConsentPDF Format
Semaglutide / BPC-157 Consent Form
Medical disclosure and informed consent agreement required for peptide weight loss therapy.
Weight ProgramPDF Format
Semaglutide — Weight Loss Tracker
Track your weekly subcutaneous dosage, body weight log, and symptom notes.
How to Submit Your Completed Forms
Option A: In Person
Print out your completed PDF forms and hand them directly to Kelly at our front desk upon arrival.
Option B: Email or Fax
Email scanned copies to our patient care desk or fax directly to (903) 355-2938.