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

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


COVID-19 Protocol


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