Instructions:

    You can cut/paste the top portion of this document into a word processor and type in the answers  The first section below is to cut out for a template. Below that is more detailed guidelines/questions to help you better inform us of your problems. Alternately you can download one of the documents below.

   

    After filling in all the information, please print the document and fax to us at 407-951-7843. 

Return patient's Form
Out of area return patient form.doc
Microsoft Word document [26.0 KB]
FLTCM Non-office visit Form
FLTCM-non-office vist form.doc
Microsoft Word document [35.5 KB]

Appointments

Use our contact form or just call us at:

 

407-951-7841

           or

407-331-7841

FREE CONSULTATION

We now ACCEPT Insurance!

Welcome Bergeron Therapeutic Join Our Team!

Call 407-951-7841

for a massage today!

Web Site: www.btherapeutics.com