PLEASE CANCEL WITHIN 24 HOURS DURING BUSINESS HOURS IF YOU ARE UNABLE TO KEEP YOUR APPOINTMENT. We appreciate your cooperation in avoiding no-shows as we have other patients who would be grateful to take your appointment time. Thank you!!
Be sure to bring the following to your evaluation appointment:
- Legal photo ID or driver's license
- Insurance card(s)
- Prescription for therapy from your physician
- Your calendar of commitments so we can schedule future appointments
- List of surgeries, prescription and over the counter medications
- Medical History Form
- Episode of Care
- Missed Visit Policy
- Authorization for Release of Private Health Information
- HIPAA Consent
- General Consent
- Demographic Sheet
Ladies only - Pelvic Patients please print:
- Pelvic History
- Pelvic Functional Outcome Measure
- Female Genitourinary Pain
- Missed Visit Policy
- Authorization for Release of Private Health Information
- HIPAA Consent
- General Consent
Men only - Pelvic Patients please print:
- Pelvic History
- Male Genitourinary Pain
- Missed Visit Policy
- Authorization for Release of Private Health Information
- HIPAA Consent
- General Consent
- Medicare Patients (Medicare patients only)
We will advise each patient which of these forms are needed to print, complete and bring to the evaluation appointment. New insurance regulations require some of these forms to be completed.
