Notice of Privacy Practices (HIPAA)

Please read the Notice of Privacy Practices statement below.

[ MS Word ]  [ PDF ]

Then print and fill out the accompanying
Notice of Privacy Practices Acknowledgement Form.

[ MS Word ]  [ PDF ]
 

Patient Record Form and Agreement

Print and fill out the Patient Record Form and Agreement.

[ MS Word ]  [ PDF ]
 

TeleHealth Consent Form

Print and fill out the TeleHealth Consent Form.

[ MS Word ]  [ PDF ]
 

Optimal Instrument Form

Print and fill out the Optimal Instrument Form.

[ PDF ]
 

Low Back Form

Print and fill out the Low Back Form.

[ PDF ]
 

Neck Form

Print and fill out the Neck Form.

[ PDF ]
 

Shoulder/Elbow/Wrist Form

Print and fill out the Shoulder/Elbow/Wrist Form.

[ PDF ]
 

Hip/Knee/Ankle Form

Print and fill out the Hip/Knee/Ankle Form.

[ PDF ]
 

Bring your completed forms to your first appointment.

Please note: These documents are provided in Adobe Acrobat^TM Portable Document File (PDF) format. If you do not have Adobe Acrobat Reader DC, you can download it for free. To download the latest FREE Reader software, click on the Adobe icon below.

KATE SCHWARTZ PHYSICAL THERAPY, LLC   187A High Street, Exeter, NH 03833    Phone: (603) 772-0708   Fax: (603) 772-3491

Home  |  Staff  |  Services  |  Forms  |  Testimonials  |  Contact

©2008-2021 KSPT. All Rights Reserved.  Site Design by Ampers&.