Scrambler Therapy Patient Forms We are committed to safeguarding your comfort throughout this process Check the boxes to keep track of your progress. This short checklist has links to help you ensure that you’ve completed all of your pre-procedural forms. Sign the Informed Consent Form. Fill out the Intake Form. Acknowledge that you have read the Pre-treatment Instructions. Acknowledge that you have read the Post-treatment Instructions. Fill out the HIPAA Privacy Policy Form so that we know how you would like to be contacted.