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