FOR PATIENTS

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)

Cancellation Policy (pdf)

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

Male:Female Bowel:Gastrointestinal Dysfunction (pdf)

Leading Vulvar Irritants (pdf)

Extra Information (pdf)

Female Urinary Incontinence (pdf)

Male Pelvic Floor Pain (pdf)

Notice of Privacy Practices (pdf)

Receipt of Privacy Practices Form (pdf)

Pregnancy Back Pain (pdf)

Telehealth Consent Form (pdf)

LUCIA D. MILLER PT, MPT, PRPC, WCS

PELVIC HEALTH PHYSICAL THERAPY

PILATES CERTIFIED INSTRUCTOR

Redwood City, CA 94062

Phone number: +1 415-763-7209

EFAX +1 650-649-2629

COVID-19 Protocol