****For the safety of our patients and staff, we respectfully ask that you wear a cloth or surgical face mask that covers your mouth and nose the entire time you are in the building. Please no masks that are mesh and/or have holes. We apologize, but there are no medical exemptions for medical facilities. If you are unwilling to wear a face mask you will be politely requested to leave. Thank you for your understanding.
Please print and fill out the entire packet to bring with you to your appointment.
Ages 6 and under- Parents (guardians), please print and fill out the entire packet to bring in with you to your child's appointment.
Please print and fill out this packet ONLY if you have been requested to do so.
Please print and fill out this form ONLY if you are being seen for biofeedback.
Please print, fill out, sign and then submit to either the facility holding your records or to our office.
Please print, fill out, sign and then submit to our office.
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