Forms
Prior to your initial visit or during your treatment, Julie may request that you complete some documentation to help reduce the amount of time during her visit and help her better assess how to treat you. Please download and complete the appropriate form below, based on your condition. If you have any questions regarding which form to use or how to complete it, contact Julie.
Client Documentation
- How to Determine Your Insurance Benefits for Physical Therapy
- Patient Information & Financial Policy
- Conditions and Consent for Physical Therapy Treatment
- Physical Therapy Referral
- Pelvic Floor Rehabilitation (download coming soon)
Patient History
- Patient History Form
- Pelvic Floor Consent for Evaluation & Treatment
- Instructions for Keeping a Record of Bladder Function
- Daily Voiding Log (download coming soon)
- Sample – Daily Voiding Log
Pelvic Floor Rehabilitation – Pediatrics
- Pediatric Consent for Evaluation & Treatment (download coming soon)
- Pediatric Health History & Screening Questionnaire (download coming soon)
- Daily Bladder Log (download coming soon)
- Your Bladder Instructions(download coming soon)