Doctor In Charge – Sign Up

Call Us at (210) 555-5555 to speak with a Doctor In Charge™ Consultant
to get signed up Immediately.


Application Forms

Please complete the forms pertaining to the level of service you wish to subscribe to.

Upon completion, please Fax back to 210-555-5555.

If you have any questions, please feel free to call us at 210-555-5555.

Doctor In Charge™ Individuals (Only $25 per month/per person/$10 copay)

Individuals Agreement & Signup Form 


Doctor In Charge™ For Business (Only $25 per month/per person/$10 copay)

Businesses Agreement & Signup Form 


Doctor-In-Charge™ VIP Concierge Service ($2500 per year)

Concierge Agreement & Signup Form 

PLEASE NOTE: All information presented in is for informational purposes only. It is not specific medical advice for any individual. All information presented on our website should not be construed as medical consultation or instruction. You should take no action solely on the basis of this publication’s contents. Life Science Medical requires blood work, lab tests, medical history examination, and physical exam before our medical staff will consider prescribing any medications. There must be a medical necessity for any prescription to be written. Completing the required medical history, lab work and physical examination does not automatically qualify you for therapy with Life Science Medical. DISCLAIMER: NO PRESCRIPTION WILL BE PROVIDED UNLESS A CLINICAL NEED EXISTS BASED ON REQUIRED LAB WORK, PHYSICIAN CONSULTATION EXAM AND CURRENT MEDICAL HISTORY EITHER THROUGH PATIENT'S PERSONAL PHYSICIAN OR LIFE SCIENCE MEDICAL PHYSICIAN. AGREEING TO LAB WORK DOES NOT AUTOMATICALLY EQUATE TO CLINICAL NECESSITY AND A PRESCRIPTION. ONLY OUR MEDICAL PROVIDERS CAN DETERMINE IF YOU QUALIFY FOR TREATMENT. All photos used in this website are not necessarily staff of Life Science Medical and may be models. The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.

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