I have received and reviewed the privacy practice notice for GameDay Men’s Health. I understand that this office will properly maintain my records and will use all due means to protect my privacy as outlined in this privacy practice statement.

I understand periodic blood tests are necessary when receiving testosterone replacement therapy and will comply with this policy.

Each patient is expected to have a full yearly physical. If you do not have a primary care physician GameDay Men’s Health will assist in locating one for you.

Your signature and date at the bottom of this form constitutes your understanding of the above information.

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