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.
2. Click below to sign legal documentation - for all doctors' appointments except Psychology.
3. Please complete the following form with how you are feeling currently:
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
6. Click below to sign authorization for psychological treatment of a minor child, if applicable:
7. If you are being referred for nerve testing only, please complete the following form:
8. For all Compulsory Medical Examinations, Examinee must sign the following:
9. For all Independent Medical Examinations, Examinee must sign the following:
10. For all Expert Evaluations, Examinee must sign the following:
11. For all Expert Psychological Evaluations, Examinee must sign the following:
12. For all Psychological Compulsory Medical Evaluations, Examinee must sign the following:
13. Please read the Notice of Privacy Practices at your convenience.
Neurology and Physical Therapy Centers of Tampa Bay
Tampa, FL
813-831-6622
2835 W. De Leon St.
Suite 205
Tampa, FL 33609
Tampa, FL
813-831-6622
2835 W. De Leon St.
Suite 205
Tampa, FL 33609