• This form and the appointment calendars are uber complex! If changes are needed, let Lark know. Thanks :D

  • PATIENT CONSULTATION FORM

    PATIENT CONSULTATION FORM

    All in-person consultations take place in our Dallas location: 8220 Abrams Rd, Dallas, TX 75231. 214-349-8000

  • Welcome to Abrams Royal Pharmacy!

    We are so happy you have chosen us to help guide you on your health care journey. Our goal is to provide you with accurate and up to date information to help you make informed choices regarding your health.

     

    In order to make the most of our time together, I respectfully request the following: 

     

      • Attach or bring copies of your labs and other documents. 
        • Please attach your labs and documents with the link at the bottom of the intake form. I cannot properly analyze your labs on your phone or device. If you are unable to attach your documents, print out copies ahead of time and bring them with you. 

     

      • Bring all current prescriptions and supplements you are taking. 
        • I understand that for some people, this may mean lugging in a big bag of bottles, and that’s ok, I don’t scare that easily😊.  
        • If you are taking supplements or prescriptions that require refrigeration, go ahead and leave those at home. Just make sure to jot down the name, brand and dose on your intake form.

     

      • Please, please please!! DO NOT wear perfume, cologne or essential oils!

        • These are migraine triggers for myself as well as several of my employees and customers.  I 

          absolutely reserve the right to reschedule your appointment without refund if I believe my health, or or that of my employees or clientelle, is being compromised.

     

      • For phone consultations:
        • The number to call for phone appointments is 214-349-8000, ext 0.   
        • Make sure to attach your labs with the link at the end of the intake form. If you are unable to attach your forms, you may email or fax them to my attention at 214-341-7966 at least 2 week-days prior to your appointment date.

     

      • For Zoom consultations: 
        • I will send you a Zoom link a few days before your appointment.  Please make sure your Zoom app is up to date prior to your consultation. 
        • Make sure to attach your labs with the link at the end of the intake form.  If you are unable to attach your forms, you may email or fax them to my attention at 214-341-7966 at least 2 week-days prior to your appointment date. 

     

      • Payment:
        • Payment is expected at the time of service. 
        • If you have a phone or Zoom call, and the pharmacy doesn't already have a card on file for you, I will send you a credit card authorization form. Please return the completed form to my attention by email or fax at 214-341-7966 at least 2 week-days prior to your appointment date.

     

      • Cancellations, Rescheduling and No-Show:
        • If you need to cancel or change your appointment time, please let us know at least 2 week-days prior to your appointment date so I can contact clients on my wait list and to avoid a $65 no-show fee.
        • If you have an illness or emergency you need to attend to, please give us a call as soon as possible and we'll be happy to reschedule your appointment.

     

      • Bring a friend
        • You are more than welcome to bring a family member or friend with you if you feel it would be beneficial.
        • Children under the age of 18 must be accompanied by a parent or legal guardian. 

     

    If you are unable to make your appointment, please call the pharmacy at 214-349-8000 or send me an email at least 2 week-days prior to your appointment date so I may contact clients on my wait list and to avoid a no-show fee. 

     

     

     

    I'm looking forward to meeting with you!

  • DOB*
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  • Format: (000) 000-0000.
  • Schedule your Appointment Time with Lark Swofford, Rph. (Dates and times that are greyed out are unavailable) If you need a date/time other than those listed, please send me an email (Lark@arp-rx.com) and I can check my calendar for availability. *
  • Consultation Format. If we are meeting over the phone or through Zoom and we do not have your payment information on file, we will send a credit card authorization form under a separate email.*
  • appointment reminder for Lark (email will be sent 2-3 days before appt)
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  • appointment reminder for Tammy (email will be sent 2-3 days before appt)
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  • Tell Me About Yourself

  • Please list your top 3 health concerns in order of their importance.*
  • Current health care provider(s) and specialty. If none, type "none" in first box.*
  • About You*
  • Family life*
  • Work or School Life*

  • Diet and Lifestyle Information

  • How many days per week do you exercise?    *        
    What type of exercise?   *         

  • Do you skip meals?            *                   
    Do you eat organically?         *               
    How often do you eat at restaurants or get takeaway?         *      
    When you go out, what are your favorite restaurants?   *

  • How much water do you drink per day?   *   
    How many cups/glasses of coffee/tea do you drink per day? *   
    How many sodas/energy drinks do you drink per day?    *         
    How many alcoholic beverages do you drink per week?            *      

  • What is your smoking status?           *      
    Do you consume chemical sweeteners?            *      
    Do you consume natural sweeteners?            *             

  • Do you find that you get colds, the flu (or Covid) often?      *         
    Do you feel you are digesting your food properly?      *      
    Do you feel bloated/gassy after you eat?      *    
    How are your bowel habits                 

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  • Allergy, Medication and History Information

  • List any allergies you have (seasonal, chemical, food, meds) If none, type "none" in the first box. *
  • Current prescription medications and their strengths. If none, type "none" in the first box. *
  • Current over the counter medications. If none, type "none" in the first box. *
  • Current vitamins and herbal supplements. If none, type "none" in the first box. *
  • Medical conditions or surgeries and dates. If none, type "none" in the first box. *
  • Family history of disease and familial relationship. If none, type "none" in the first box.*
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