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Call Us: (608) 849-4040

Evaluation 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