Wendy M. Featherstone PT, DPT

Jennifer Morin PT, MSPT, OCS

Susan N. Thomas PT

   
 

Please read the HIPAA Privacy Notice. It is not required to print this notice.

All patients are required to print and complete the gender associated Patient Intake Form, the Authorization for Communication, the Acknowlegement of Receipt of Privacy Policies, and the Insurance and Payment Policies prior to their first appointment.

If we require additional paperwork (found on this page) from you, you will be informed as to which forms pertain to your treatment when you schedule your appointment.


REQUIRED BY ALL NEW PATIENTS:

1) Patient Intake Form (Female)

2) Patient Intake Form (Male)

3) Patient Intake Form (Pediatric, 12 and under)

4) HIPAA Privacy Notice

5) Acknowlegement of Receipt of Privacy Policies

6) Authorization for Communication

7) Insurance payment and Cancellation Policies


FUNCTIONAL OUTCOME FORMS (UPON REQUEST BY THERAPIST):

8) Chronic Pain Form (Male)

9) Chronic Pain Form (Female)

10) Colorectal Questionnaire

11) Prolapse Questionnaire

12) Pregnancy Mobility Questionnaire

13) Low Back Questionnaire

14) Bladder Questionnaire

15) Patient Assessment Questionnaire

16) Pediatric Incontinence Questionnaire


 
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