Ultimate Therapy

your source for healing

Patient information forms
Please complete, print and bring with you on your first appointment.
  • Initial Evaluation Intake Form
  • Assignment of Benefits
  • Patient Registration
Important information for your review (information will be discussed on your first appointment):
  • Company Policies
  • Notice of Privacy Practices 
If you are being treated for pelvic pain, incontinence or any other Women's Health issues, please fill out the Women's Health Intake form as well as the Consent to Treat forms below.
  • Womens Health Intake Form
  • Womens Health Consent to Treat Form


Ultimate Therapy   •  Blair Building, Suite 202  •  40900 Merchant Lane  •  Leonardtown, MD   20650 301.997.1155

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massage / balancing

lymphedema management

CranioSacral Therapy

Polarity Therapy

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cancer rehabilitation

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