Forms & Consents

Back to Health Physical Medicine offers our patients an online patient intake link to be completed in the convenience of your own home or office prior to your appointment.

Please note that this information must be filled out and submitted before your scheduled appointment. Failure to do so will result in the rescheduling of your appointment. Please call our office if for any reason you have trouble completing your intake before you scheduled appointment.

*You will not be able to complete this intake with any smartphone device.

For iPads, use your finger to sign and submit.

For laptops and desktops use your mouse to sign and submit.