Patient Forms

When scheduling as a new patient, you will be invited via email to sign up for our patient portal through Charm Health. You can access our fillable intake forms there and securely return them to us via the portal. The portal is a great way to communicate with us, reschedule appointments and view treatment plans, handouts and lab results. If you have trouble utilizing the portal and prefer to print and fill out forms, we have these options for you below. They must be return via email or fax at least one week prior to your appointment. Forms can be emailed to: support@trilliumnatural.com or faxed to (412) 571-9355. If you are a new patient coming in for a fertility consult, please fill out both the Adult Patient Packet and the Fertility Healthy History. If you would prefer to have us mail you a paper copy, please let us know. Thank you!

• Adult Patient Packet
• Fertility Health History
• Pediatric Patient Packet – (birth to 5 years old)
• Pediatric Patient Packet – (6 years to 12 years old)
• Notice of Privacy Practices – Please read this form before your first appointment. It is not necessary to print it.