Patient Forms
Welcome to MD Wellness Center and Med Spa
Once you have confirmed your appointment date, please download the appropriate intake forms. These forms may include a number of questions addressing diet, lifestyle, past medical history, and family medical history. They also include consent and release forms. Please take the timeto fill these out completely.
Bring these completed, signed intake forms when you come for your first appointment. This will save you time and ensure that your treatment starts on time
Please download the right intake form on your computer, fill and ensure it is saved, and send the forms to contact@mytrimmd.com
STEP 1: Download the file into your device. See our how-to-download video (on a Mac) below.
STEP 2: Open the file and fill it out. And then SAVE (click the SAVE button shown in the image below or for some devices, you may have to click the DOWNLOAD button again).

Step 3: Email the filled out form to contact@mytrimmd.com via email attachment.
Medical Weight Loss Appointment:
Body Contouring and Aesthetics Appointment:
Bio-Identical Hormones:
For Women:
For Men:
Sexual Wellness:
For Women:
For Men:
Hair Loss Appointment:
If you have any questions or need any information, please feel free to call us at 317 548 4666 or 317 650 2501 or email us at contact@mytrimmd.com.