Patient Forms

Thank you for selecting RevitaLife for your health and wellness care.

Please call (314) 475-3126 to make an appointment.

Once you have made your initial appointment, you can pre-register by clicking on the links for New Patient Forms below. Simply download, print, and complete the forms prior to your arrival. Doing so will help speed up the new patient registration process at your first visit.

Downloadable Patient Registration Forms

• New Patient Information Form (PDF)
• Existing Patient Update Information Form (PDF)
• Medical Records Release Form (PDF) For RevitaLife to acquire records from another doctor or hospital.
• Medical Records Request Form (PDF) To ask RevitaLife to send records to another doctor or hospital.