Pelvic Health Therapy Services Online Registration
Thank you for choosing UH Lake Health Rehab Services for your care. Please complete your online registration packet no later than two business days before your appointment. Please complete the entire form, unless our office staff has asked you to complete only certain sections. The information you provide is used for your medical record and insurance verification purposes. If you have any questions, please contact our office. Your digital signature and acknowledgement(s) on the following policies and forms are legally binding and carry the same importance as a physical signature. If you need a guarantor or guardian witness signature on any section of this form, please complete the form with them present to provide their acknowledgement.