As a convenience, we are happy to provide the following forms on our website.
First-Time Patient Forms
Please complete the following two forms prior to your first appointment. These are required as they are your consent for treatment, as well as our cancellation policy, your authorization for release of medical records and your financial and insurance responsibilities:
Informed Consent Form
Medical History Questionnaire
Outcome Measure Forms
Please complete the following at your therapist’s request.
Male Prostatitis Symptoms Index
Female Prostatitis Symptoms Index
Vulvar Pain Index
Female Sexual Function Index
Oswestry Disability Index
Pelvic Floor Disability Index (PFDI-20)
Initial Pelvic Pain Inventory
Pelvic Pain Goal Inventory Status
Pelvic Floor Inventory Questionnaire (PFIQ-7)