(c)                    "Function is our Focus"   Sensory Therapeutics Inc.  

We look forward to telling you more about Vestibular and Balance Rehabilitation.

Please call (561) 745-0028 if you would like to make an appointment for your initial evaluation. Or click on this link to contact us by email.

 You can print and complete the NEW PATIENT INTAKE PACKET at home. Click the name of each form to view and print this information in a PDF file format. Please bring the completed forms with you to your first appointment to save you from having to fill them out in the office.

If you have United Health Care for your insurer, please click on this link to obtain an additional necessary form. Only complete the bottom section of the form (Patient Completes This Section) as it relates to your dizziness and imbalance symptoms. 

If you would like us to send your confidential medical information to another provider you will need to complete the Medical Release Form/Disclosure Form.

NEW PATIENT

INTAKE PACKET

Please click on the below links to print out each individual form. All forms should be fully completed and brought with you to your initial appointment.

• Patient Info Sheet
  
  

• Financial Responsibility
  

• HIPAA Notice of Privacy Practices
  

• Medical History
  

• Dizziness Handicap Inventory
  

• Falls Efficacy Scale
  

• *Medicare Financial Limitation *Only Medicare recipients need to complete this form.

Click here for a list of our Participating Insurance Networks