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Now at two convenient locations! Shreveport & Haughton!

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Jeter Therapy Group
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Jeter Therapy Group

Patient Forms

Child Intake Form

Adult Intake Form

Formulario de Admisión- Niño(a) Español

Health Insurance Verification Form

Acknowledgement & Assumption of Risk

Acknowledgement of HIPAA Privacy Notice

General Acknowledgement of Forms

Payment Policy Form

Consent for Services

Communication Preferences Form

Attendance / Cancellation Policy

Records Release Authorization Form

Payment On File Form

COVID-19 Liability Waiver

Two convenient locations in Shreveport and Haughton. Call us today at 318-219-6064!
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