Ron French, OT, CHT

Occupational Therapist

Certified Hand Therapist


Patient Forms

REGISTRATION FORMS:  Click the form(s) you would like to print...

-Click here to print all patient forms (5 pages)

-Patient Registration Form: Provides basic information to file insurance claims and acknowledges patient responsibility (1 page)

-Patient Medical History: Provides specific information about current condition plus general health information and medications (2 pages)

-Privacy Policy Acknowledgement/Coordination of Care: Please review our privacy policy and sign (1 page)

-Privacy Policy: Please review our privacy policy (this is for your information, you do not need to bring ​a copy to your appointment, 1page)

Additional Forms:  Click the form(s) you would like to print...

-Medical Record Release Form

-Medical Record Amendment Request

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