Forms

Forms

 
New patients are asked to fill out the new patient intake sheet before their first apppointment. Bring the completed, signed form, along with your insurance card and picture ID. (You must have the proper ID or you will be asked to reschedule your appontment.)

If you need to cancel or reschedule an appointment, you are required to provide us 24 hour notice.

It is the patient’s responsibility to know their insurance benefits. You are expected to pay any copays and/or deductibles at the time of your visit. All balances not paid by the insurance company are billed to the patient. We accept cash, check, and most major credit cards.



 
Please click on the followings links to print or view other forms and policies:

Continence questionnaire (female)  Continence questionnaire (male)

Vestibular questionnaire                    Pelvic pain questionnaire

Appointment no-show policy         HIPPA notice of privacy practices