• Leading RIT provider in the Tampay Bay Area
  • Leading RIT provider in the Tampay Bay Area
  • Leading RIT provider in the Tampay Bay Area
Patient Registration Forms

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This is form must be signed before injection therapy is performed.  It is similar to the form used in the hospital or doctors' office before any surgical procedure is begun.  It explains all the possible risks involved in the procedure and your signature indicates your comprehension and acknowledgement of same.
This form should be completed for all new patients and used as a progress report during treatment.
This form must be completed by all new patients and updated when their information has changed i.e. address, insurance, etc.
This form must be signed by all new patients.  It indicates the patient knows that Dr. Linetsky does not carry malpractice insurance and holds him harmless.

Office Location

Druhill Professional Center
611 Druid Rd East
Suite 303
Clearwater FL 33756
Phone: 727-787-5555
Map

 

Office Hours

Monday thru Friday
10am - 6pm
Contact our office.