Online Forms

Please fill out the following forms, print, and bring them with you to the clinic on the day of your initial evaluation. Please leave the signature line blank so you can sign in the clinic in front of the office staff. NOTE: If you are using an iPad, you will need the free Adobe Reader app. Download on your iPad from the App Store link on your home screen.

BLPT New Patient Intake Form

BLPT RETURNING PATIENT Intake Form for Previously Treated Problem

Please fill out this additional form if you are being seen for pelvic floor dysfunction (incontinence, pelvic pain, and/or pregnancy)

BLPT Pelvic Floor Questionnaire