Tina L Baum, Physical Therapist - las vegas physical therapists chronic pelvic pain physical t and las vegas physical therapists pelvic pain physical therapy

Download New Patient Paperwork

Please click on the links below to download new patient paperwork. If you are unclear which documents to download, please call the office at 702-877-2000. If the correct paperwork is not downloaded correctly and/or not filled out, it may compromise your treatment time.

Patient Information/Financial Responsibility/Cancellation Policy/HIPAA Signature Page

All New Patients Need These Forms Please review the HIPPA policy before signing the HIPAA Signature Page If you are unable to download forms, please come to your first visit 30 minutes early to complete them at the clinic.

Body Pain Map

All New Patients Need This Form If you are unable to download forms, please come to your first visit 30 minutes early to complete them at the clinic.

Medical Screening Questionnare

All new Patients Need This Form If you are unable to download forms, please come to your first visit 30 minutes early to complete them at the clinic.

Bladder and Bowel Symptom Questionaire (Women and Men)

This form is for patients that have Incontinence (bladder or rectal leaking), Chronic Pelvic Pain or Abnormal Bowel/Bladder Symptoms. If you are unable to download forms, please come to your first visit 30 minutes early to complete them at the clinic.

Male Pelvic Pain Questionnaire

This form is for patients that have Groin Pain or Genital Pain. Male's only. If you are unable to download forms, please come to your first visit 30 minutes early to complete them at the clinic.

Lymphedema

Patient Consent form Photograph and Medical History for Lymphedema and Breast Cancer Patients If you are unable to download forms, please come to your first visit 30 minutes early to complete them at the clinic.