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    • Home
    • Appointments
    • For Patients
    • About Me
    • Services
    • Products
    • Contact
  • Home
  • Appointments
  • For Patients
  • About Me
  • Services
  • Products
  • Contact

FOR PATIENTS

Patient Information Forms

All patient information forms are available on the Jane.com website. If you are unable to download and print them, download the PDFs linked below.

Patient Information Sheet

Patient Information Sheet (pdf)

Download

CANCELLATION POLICY

Cancellation Policy (pdf)

Download

CONSENT FORM

Consent Form for Pelvic Floor Treatment (2 pages) (pdf)

Download

MEDICAL HISTORY

Male:Female Bowel:Gastrointestinal Dysfunction (pdf)

Download

EXERCISES & EDUCATION

Leading Vulvar Irritants (pdf)

Download

GENERAL INTAKE FORMS

Extra Information (pdf)

Download

Female Urinary Incontinence (pdf)

Download

Male Pelvic Floor Pain (pdf)

Download

Notice of Privacy Practices (pdf)

Download

Receipt of Privacy Practices Form (pdf)

Download

Pregnancy Back Pain (pdf)

Download

Telehealth Consent Form (pdf)

Download

LUCIA D. MILLER PT, MPT, PRPC, WCS 

PELVIC HEALTH PHYSICAL THERAPY

PILATES CERTIFIED INSTRUCTOR


SCHEDULE AN IN-PERSON OR TELEHEALTH APPOINTMENT

Redwood City, CA 94062

lucia@luciamiller.com

Phone number: +1 415-763-7209

EFAX +1 650-649-2629


COVID-19 Protocol


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