To search type and hit enter

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 emailed to you after scheduling your appointment. But we understand that sometimes emails get lost, so we have made them available online.

Click on the following links to access the forms.

New Patient- Child Medical History

New Patient- Adult Medical History

New Patient- Adult Medical History- Brain Injury/Concussion

Brain Injury/Concussion Symptom Checklist

Near-Work Stress Symptom Questionnaire

HIPPA Policy

Insurance & Billing Information

Medical Records Release