Participants in the Bellevue Patient Empowerment Program receive a phone or in-office consultation with one of our pharmacists. During this consultation we discuss your symptoms, any pertinent laboratory results, alternative therapies you may discuss with your doctor, and the risks and benefits of these therapies. Also included in the program, our pharmacists will document our assessment and therapeutic recommendations for you, which may include bioidentical hormone replacement therapy. This clinical documentation is then provided to you and your physician to facilitate your discussion with your doctor. If you do not have a physician who will prescribe for you the therapy we discuss, we can provide you with a referral to a physician in your area who may be more open to such therapy alternatives. The fee for this program is $2 per minute, 15 minute minimum.

Patient Empowerment Program Process

• Evaluate patient by means of completed patient history form and or phone consultation
• Measure baseline hormone levels through Aeron Laboratory saliva testing service or recent blood tests
• Discuss risks and benefits of therapy alternatives
• Recommend customized hormone therapy to your doctor or physician referral
• Prepare customized hormone therapy protocol from Bellevue Pharmacy
• Monitor and maintain individualized patient therapy through continued consultation and saliva testing

STEP ONE:

Complete the Patient History Forms online, or download the forms in PDF format then print and fax or mail the completed forms to Bellevue Pharmacy, 1034 S. Brentwood Boulevard, Suite 102, St. Louis, MO 63117 (local fax: 314-727-2830 / toll free fax: 800-458-9182.)

We will review your information and contact you to schedule a consultation time with a pharmacist.

• Women's Online Patient History Form
• Women's Printable Patient History Form (PDF Download / 9 pages / 221k)
• Men's Online Patient History Form
• Men's Printable Patient History Form (PDF Download / 6 pages / 60k)

STEP TWO:

We believe it is very important to utilize laboratory tests of hormone levels in our assessment of your hormonal status, and to incorporate this information into our recommendations. We encourage you to complete saliva testing, although we will review blood tests if you have the appropriate tests available. For women, we generally recommend testing Estradiol, Progesterone, Testosterone and DHEA. For men, we recommend testing Testosterone, Estradiol and DHEA. You can order this test from our website at the following link: www.bellevuerx.com/hormone/lab.asp

The saliva hormone test results will be mailed to you. When your saliva test results are received, Bellevue Pharmacy will contact you to schedule a consultation with one of our pharmacists to discuss a bHT protocol designed for you.

This test can be ordered without your doctor's signature if you are from one of the following states:

• Alaska
• Colorado
• Delaware
• Indiana
• Kansas
• Louisiana
• Minnesota
• Mississippi
• Missouri
• Montana
• Nebraska
• New Hampshire
• New Mexico
• Ohio
• Oklahoma
• South Dakota
• Texas
• Utah
• Vermont
• Virginia
• Washington
• Washington DC
• West Virginia
• Wisconsin

If you do not live in one of the above listed states, or want this testing to be billed to your insurance, you must have your physician authroize the test.

With your physician's autorization, Aeron Lifecycles Laboratory can bill the following insurance plans: Blue Cross/Blue Shield, United Health Care, and Pacificare.

STEP THREE:

Our recommendations will be emailed to you for discussion with your physician. The last page of our recommendations include a fax back sheet for your physician's approval. Alternatively, new prescriptions can be phoned, faxed or mailed to our attention. We will compound and ship your prescriptions from Bellevue Pharmacy once your physician approves the prescription.

STEP FOUR:

As a patient of our pharmacy, you may receive a once a month complimentary follow-up consultation with a consultant pharmacist when your prescription refills are due to evaluate your progress. Additional consultations will be charged at $2.00 per minute. After being stabilized on your customized prescription, we recommend follow-up saliva hormone testing and analysis after 3 months symptom-free treatment and annually thereafter.

If you would like to enroll in our consultation service, please return to Step I above and follow the directions provided or click here.