FORMS

You can  print  and complete the NEW PATIENT INTAKE PACKET at home. Click the  name  of each appropriate form or the icon 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. Remember to bring your insurance card (s) and your doctor's prescription / referral.

All patients, please click on the above title name to print out  your intake forms. All forms should be fully completed and brought with you to your initial appointment.  

Only Medicare recipients need to complete these forms including the above New Patient Intake forms.

If you have United Health Care for your insurer, please click for this additional necessary form including the full packet of new patient intake forms. Only complete the bottom section of the form (Patient Completes This Section) as it relates to your dizziness and imbalance symptoms. 

Insurances networks in which we currently participate.

If you would like us to send your confidential medical information to another provider, HIPAA regulations require you to complete this Medical Release / Disclosure Form. 

You can read or print out a complete copy of Notice of Privacy Practices detailing recent changes to the HIPAA Privacy, Security and Breach Notification Rules.

Doctor's offices can download our Prescription for Therapy Services form. Please fax to our office at (561) 745-0833.

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Occupational and Physical Therapists who specialize in Vestibular Rehabilitation treat people who have issues with dizziness, vertigo and imbalance. They treat people with BPPV, Meniere's Disease, Acoustic Neuroma. Pre and post surgery. Imbalance. Falls Prevention.

© 2016 All rights reserved. 
 

210 Jupiter Lakes Blvd.

Building 4000, Suite 201

Jupiter, FL 33458

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