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RE: Robert's 1/13/2012 appointment



Hi Robert,

For today's appointment, please fill out the attached paperwork. You should
also bring your photo ID and insurance card. For the patient demographics
page, we only need you to fill out the first two sections. We will complete
the insurance information in the office.

If you have any questions, please give us a call. We'll see you at 4 pm.

Regards, Cara

Vortex Physical Therapy & Balance
http://www.vortexpt.com/~cara
408-540-7622 office

-----Original Message-----
From: robert b [http://www.snkmail.com/~kgthqybggm]
Sent: Friday, January 06, 2012 8:26 AM
To: http://www.vortexpt.com/~info
Subject: Robert's 1/13/2012 appointment

Please send me the forms that need filling out.

Thanks.

Attachment: 3 Patient Financial Policy_Patient Consent 12.01.11.pdf
Description: Adobe PDF document

Attachment: 1 Patient Demographics 12.01.11.pdf
Description: Adobe PDF document

Attachment: 2 Medical History 12.01.11.pdf
Description: Adobe PDF document

Attachment: 4 Notice of Privacy_Patient Signature 11.03.11.pdf
Description: Adobe PDF document

Attachment: 6 Dizziness Handicap Inventory DHI.pdf
Description: Adobe PDF document



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