Notice of Privacy Practices

Please read the Notice of Privacy Practices statement below.

[ 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 ]
 

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 Reader, 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

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