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PRINTABLE VERSION

Hormone Replacement Therapy Program Protocol Diary


Monitoring Program: Please take a moment and save this Microsoft word document on your local computer, the purpose of this to capture your health and wellness goals each day in diary form. Please write the dates next to the Week # and the date and times, for each day of the week when documenting items.

Record: medication used, how much and at what time, your diet (what you ate), work hours and exercise for the particular day. Note in this document any other issues which may be of concern for your personal health representative.


Week 1:

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Week 12:

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Copyright © 2010 HGH Prescription


Last updated on Wednesday, February 08, 2012

NO PRESCRIPTION WILL BE PROVIDED UNLESS A CLINICAL NEED EXISTS BASED ON REQUIRED LAB WORK, PHYSICIAN CONSULTATION, PHYSICAL EXAMINATION AND CURRENT MEDICAL HISTORY. PLEASE NOTE, AGREEING TO LAB WORK AND PHYSICAL EXAM DOES NOT GUARANTEE A FINDING OF CLINICAL NECESSITY AND A PRESCRIPTION.