Patient Login
21756 STATE ROAD 54, SUITE 102A, LUTZ, FL 33549-2905, TEL: 813-443-5817
Contact Our Office
Meet the Doctor
Make an Appointment
Accepted Insurances
Directions and Hours
Patient Education
Billing Questions
Forms
Forms
Please fill out the following forms and bring them with you to your appointment.
General Health Review Form
Confidential Registration Sheet
Consent For Care And Treatment
Initial Pain Assessment
Pain Practice Financial Policy
Acknowledgement Of Receipt
Authorization For Use Of Disclosure Of Health Information To Be Released
HIPPA NOTICE OF PRIVACY PRACTICES
These forms require
Adobe Reader
. If you do not have Adobe Reader, you may download it free from here: