All Patients

Thank you for choosing us to provide you with rehabilitation services. We want to ensure that your visit is as smooth as possible and that all of your questions are answered.

HIPAA Notice of Privacy Practices (March 2015)

Specialty Services Patients:

These additional forms are for Male and Female patients that are being treated for Specialty Services at Results Physiotherapy, including Pelvic Health, Incontinence, Women’s Health and Sexual Dysfunction.
*Please note that these are comprehensive medical history forms that include questions that cover several different pelvic health conditions that a patient may be seeking therapy for. Patients only need to answer questions associated with the problems they are experiencing or being referred to therapy for.

Female Specialty Services History and Intake Form (PDF)

Male Specialty Services History and Intake Form (PDF)

Consent for Pelvic Floor Muscle Evaluation (PDF)

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