Universal Health & Rehabilitation

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New Patient Intake Online Submission Form

Due to the COVID 19 Epidemic, we are currently offering an online Initial Intake Portal for New Patients. 


As a new patient we require certain personal and health information to ensure that you receive the best possible care.  


You have the option to complete the paperless form to the right, or print off the forms below and bring them with you to you first appointment.  

New Patient Online Intake Form!

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