All patient forms can be found on this page. The forms can be filled in digitally or can be printed and filled in by hand.
Permission To Treat
Before we treat you, we need your permission in written.
It Explains our rules for cancellations.
Patient Intake Form
Patient’s personal and contact information.
Payment is due at the time of service.
Medical history and subjective report
Brief collection of patient’s medical history and symptoms perception.
After scheduling your initial evaluation, please complete all forms and submit them to:
Mail address: 1866 Harrier Avenue, Clermont, Florida 34711
FREE 15 MINUTE PHONE CONSULT
Have questions and want to see whether I’m a good fit for you?
Please set up a FREE 15 minute phone consultation so we can chat. No pressure. Honestly.