Patient Forms for New Patients


Instructions:  All new patients complete Section 1 (General) AND either Section 2 (Orthopedic) or Section 3 (Pelvic Floor)


SECTION 1

General Intake Forms: ALL New Patients will complete 

These are the forms that all new patients will be asked to fill out and bring to their first appointment:

  1. Patient Information Sheet (1 page)
  2. Cancellation Policy (1 page)
  3. Notice of Privacy Practices (READ-ONLY: for your information only; please do not bring to your appointment)
  4. Receipt of Privacy Practices (1 page)
  5. Extra Info: “MIPS” (1 page)
  6. Depression Intake Scale (1 page, if you have a diagnosis of depression or bipolar, you do NOT need to do this form)
  7. Telehealth Consent: Only for patients doing Telehealth (print only the last page and sign)

SECTION 2

Orthopedic Forms: Orthopedic Patients ONLY

In addition to the general intake forms, please fill out the following:

SECTION 3- Complete these forms if you have a pelvic floor problem. 

Pelvic Floor Forms: Pelvic Floor Patients ONLY

In addition to the general intake forms, please fill out the following:

  1. Consent Form for Pelvic Floor Treatment (2 pages)
  2. ONE of the following questionnaires depending on your symptoms:

For questions or more information

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