• Skip to primary navigation
  • Skip to main content
Wellspring

Wellspring

clinic

  • SERVICES
    • HORMONE THERAPY
      • Bio-Identical Hormone Replacement Therapy (BHRT)
      • Hormone Optimization for Women
      • Pellet Therapy for Hormone Imbalance
    • SEXUAL HEALTH
      • ACOUSTIC WAVE THERAPY
      • TRIMIX
    • PAIN MANAGEMENT
    • IV NUTRIENT THERAPY
    • DETOXIFICATION
    • OZONE THERAPY
    • WEIGHT LOSS INJECTIONS
  • INFORMATION
    • PATIENT FORMS
    • NEWS/BLOG
    • TESTIMONIALS
  • CONTACT
  • ABOUT
  • HORMONE QUIZ
  • ORIENTATIONS

480.861.3916
drdagstani@gmail.com

PATIENT FORMS

Thank you for choosing WellSpring Restorative Health for your care. For your convenience, we have provided you with downloadable patient forms and documents: Click to download NOTE: For Apple users, download may encounter some difficulty using Safari. We recommend Chrome or Firefox if this problem persists.

Note: You may fill this out on your computer, but you do need to save it to your computer and attach it to an email and return to us or bring it into our office for your appointment. 

Female Patient Form

Male Patient Form

  • SERVICES
    • HORMONE THERAPY
      • Bio-Identical Hormone Replacement Therapy (BHRT)
      • Hormone Optimization for Women
      • Pellet Therapy for Hormone Imbalance
    • SEXUAL HEALTH
      • ACOUSTIC WAVE THERAPY
      • TRIMIX
    • PAIN MANAGEMENT
    • IV NUTRIENT THERAPY
    • DETOXIFICATION
    • OZONE THERAPY
    • WEIGHT LOSS INJECTIONS
  • INFORMATION
    • PATIENT FORMS
    • NEWS/BLOG
    • TESTIMONIALS
  • CONTACT
  • ABOUT
  • HORMONE QUIZ
  • ORIENTATIONS

Wellspring Restorative Health

Health Matters Most


Contact Us Anywhere, Anytime!

480-861.3916

 

Serving you from 2 locations:

1947 McCulloch Blvd Suite 101, Lake Havasu City AZ 86403

Click to open a larger map

1751 N Stockton Hill Road Suite B, Kingman AZ 86401

Click to open a larger map

Copyright © 2025 · WellSpring Restorative Health - 480-660-3214; All Rights Reserved