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Robin@elevateptandperformance.com

(701) 746-5779

FORMS FOR PATIENTS

Forms can be filled out and brought to your first appointment or you can fill them out at your appointment

CONFIDENTIAL HEALTH HISTORY FORM

Please fill out and sign this form for your initial evaluation.

HIPAA GUIDELINES

Please read these guidelines regarding your rights to privacy regarding your health information.

NOTICE OF PRIVACY PRACTICES ACKNOWLEDGEMENT

Please sign this form after reading the HIPAA Guidelines.

DRY NEEDLING CONSENT FORM

Please read and fill out this form if you would like to try Dry Needling at your appointment.

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