Save time at your first visit by completing your paperwork ahead of time. Print the forms below, fill them out, and bring them to your first appointment.
Every new patient completes this packet. It includes your patient information and HIPAA acknowledgment, our scheduling and billing policy, your medical history and medications, and a body chart to mark your symptoms
Coming in for pelvic health therapy? Please complete the New Patient Packet and this intake packet, which includes a detailed history, a symptom questionnaire, and the informed consent for your evaluation.
Completed forms · Insurance card · Photo ID · Referral or prescription, if you have one.
Can’t print? Arrive 15 minutes early and we’ll have copies ready. Completed forms can also be faxed to 517-339-4597. Please don’t email completed forms, since regular email isn’t secure for health information
Questions about your paperwork? Call us at (517) 339-4050
