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.

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.