Patient Forms and Portal Access for VitaLife Longevity Medicine

Covers your monthly fee, what services are included and excluded, cancellation terms, and a clear statement that DPC membership is not insurance.

Basic demographics: name, date of birth, contact info, emergency contact, preferred pharmacy, and communication preferences. No insurance fields.

The most detailed form. Covers medical conditions, past surgeries, current medications, allergies, family history, social history, review of systems, and immunization records.

Federally required acknowledgment that you have received and reviewed our privacy practices. Standard for every medical practice.

Authorization for your provider to perform examinations, procedures, and telehealth consultations as part of your care.

Authorization for VitaLife to request your medical records from previous providers. Helps Courtney see the full picture before your first visit.

Optional but recommended. Covers your wellness goals, stress levels, sleep quality, nutrition habits, exercise routine, supplement use, and which VitaLife services interest you most.

Step 1

Get Your Portal Link

After scheduling your first appointment, you will receive an email or text with a link to create your Optimantra patient portal account.

Step 2

Complete at Home

Log in from any device and work through the forms at your own pace. Most patients finish everything in 10-15 minutes. Save and come back if you need to.

Step 3

Show Up Ready

Your provider reviews your completed forms before your visit. That means your appointment starts with a conversation, not a clipboard.