Patient Registration
Please print and fill out all of the following forms prior to visiting us.
And one of the following forms:
- General Intake Questionnaire (used for most diagnoses)
- Women's Health Intake Questionnaire (complete for pelvic pain or incontinence diagnoses)
- Men’s Health Intake Questionnaire (complete for pelvic pain or incontinence diagnoses)
- Wheelchair Intake Questionnaire (complete if you are being seen for a wheelchair fitting)
- Lymphedema Questionnaire (complete only if you are being seen for lymphedema)
- ALS Questionnaire (complete only if you are being seen for ALS)
If you have a question of what form to use please contact our office at 605-334-5630 or
1-888-372-2629.
Acrobat Reader 4.0 or higher is required to open the above forms. To download and get help using the Adobe Acrobat Reader, please click here.
