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Call Us: (608) 849-4040

Evaluation Forms

Forms

Before Dr. Frazer sees you for an evaluation, there are a few forms she would like you to fill out. The appropriate forms will be mailed or emailed to you after scheduling your appointment. But we understand that sometimes these forms get misplaced, so we have made them available online.

Click on the following forms to download to your computer. You must have Acrobat Reader to open and read these documents.

Child Medical History

Adult Medical History

TBI Checklist

Quality of Life Checklist

Near-Work Questionnaire

HIPPA Policy

Insurance & Billing Information

Medical Records Release