Begin Your Journey

Book Your Private Consultation

Complete your medical history below so Dr. Pedersen can prepare a personalized treatment plan before your appointment.

Patient Info

Goals

Medical History

Lifestyle

Disclosures

Review & Sign

Section 1

Patient Information

Full Name *

Date of Birth *

Phone Number *

Email Address *

Area of Interest

Emergency Contact

Name

Relationship

Phone

This intake form is for clinical review only and does not constitute a prescription or medical advice. All treatments require a consultation with Dr. Pedersen prior to initiation.

Contact

1022 Main Street, Ste A

Dunedin, FL 34698

(727) 239-4601

[email protected]

By appointment only

Mon – Fri, 9am – 5pm

What to Expect

Complete the 6-step intake form at your own pace
Dr. Pedersen reviews your history before your visit
Personalized treatment plan prepared in advance
Team confirms your appointment within one business day