Phone: 434-960-4434

  • Home
  • Mission Statement
  • About Us
  • Common Conditions Treated
  • What to expect
  • Fee schedule/insurance
  • Forms
  • Driving directions
  • Helpful links
  • Reviews
  • More
    • Home
    • Mission Statement
    • About Us
    • Common Conditions Treated
    • What to expect
    • Fee schedule/insurance
    • Forms
    • Driving directions
    • Helpful links
    • Reviews

Phone: 434-960-4434

  • Home
  • Mission Statement
  • About Us
  • Common Conditions Treated
  • What to expect
  • Fee schedule/insurance
  • Forms
  • Driving directions
  • Helpful links
  • Reviews

Required and optional forms for new patients

New patient intake form

Health history questionnaire

New patient intake form

Required for all new patients


https://lewispft.com/uploads/New_Patient_Intake_Form.pdf 

Informed consent form

Health history questionnaire

New patient intake form

Required for all new patients


https://lewispft.com/uploads/New_Informed_Consent.pdf 

Health history questionnaire

Health history questionnaire

Health history questionnaire

Required for all new patients


https://lewispft.com/uploads/New_Health_Questionnaire.pdf 

Bladder health quiz

Insurance benefit worksheet

Health history questionnaire

Required for patients with urinary complaints


https://lewispft.com/uploads/New_Bladder_Health_Quiz.pdf
 

Insurance benefit worksheet

Insurance benefit worksheet

Insurance benefit worksheet

 Optional info. for help in filing insurance


https://lewispft.com/uploads/5_Insurance_Benefits_worksheet.doc



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