Prior to the date of your telehealth visit, for all patients, please complete the following:
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):  
​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.  For all Washington State Patients, please sign the following Telemedicine Consent Form:  
14. 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