NPT CENTERS
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Prior to the date of your telehealth visit, for all patients, please complete the following:
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New patients only, please complete the following:

1. Click below and Complete the New Patient Questionnaire.
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​2. Click below to sign legal documentation - for all doctors' appointments except Psychology.
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​3. Please complete the following form with how you are feeling ​currently:
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​4. Immediately following your visit, please sign the Disclosure Form below (for Auto Accidents):  

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​5. Click below to sign legal documentation for Psychology, with Dr. Shelley Tindell-Nodine

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​6. Click below to sign authorization for psychological treatment of a minor child, if applicable:

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7. If you are being referred for nerve testing only, please complete the following form: 
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8.  For all Independent Medical Examinations, Examinee must sign the following: 
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9. For all Expert Evaluations, Examinee must sign the following: 

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10.  For all Expert Psychological Evaluations, Examinee must sign the following: 

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11.  For all Psychological Compulsory Medical Evaluations, Examinee must sign the following: 
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12. Please read the Notice of Privacy Practices at your convenience.
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Neurology and Physical Therapy Centers of Tampa Bay
Tampa, FL

813-831-6622
2835 W. De Leon St.
Suite 205
​Tampa, FL  33609


Location

address

2835 W De Leon St
Suite 205
Tampa, FL 33609



contact us

Please call Monday through Friday 8:00A.M. - 4:00 P.M.
Phone: (813) 831-6622

Fax: (813) 874-1936

​info@tampamd.info
  • Home
    • Neurology
    • Psychology & Neuropsychology
    • Audiology
    • Physical Therapy
  • Our staff
  • Insurance
    • Workers Compensation Services
  • Directions
  • Patient Forms