3125 Blue Lake Drive, Vestavia, AL 35243 | Tel: (205)969-7887 Fax: (205)969-7886 | info@myagilept.com

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Patient Forms

 

For the convenience of our patients and clients, we have made our forms available.

Please PRINT and FILL out the following forms:

 

New Patient Information Registration Form

Medical History Form

HIPPA Patient Privacy Act Notice

Patient Procedural Policy

Dancer Questionnaire (if patient is a dancer)

The Studio Form (Pilates)

 

We appreciate you taking the time to carefully read and answer all the questions and information contained in these documents. They contain important information that will help us better serve you.

 

Please arrive 15 minutes early to your appointment and bring the forms with you along with your

driver's license and insurance card or fax them to (205)969-7886.

 

Please click the icon to download each form.