Patient Information/Forms

PLEASE PRINT BOTH ITEMS 

Patient Registration

Medical History

*We typically are considered out of network for most insurances. We Are in network with a few plans. Most insurances have coverage for in/out of network. Some can vary on each plan.  Our staff would be happy to help you find out what your insurance is estimated for coverage. You are responsible for charges at the time of service. Insurance plans and payment can be discusses anytime.

 

Referral Form (Front)  (Back)

 

Email: frontdesk@paulshowers.com

 

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