$99 New Patient Special — Consultation, Examination, Report of Findings and First Treatment Get started ›
Connecticut Disc and Laser Therapy Centers

New Patients · Shelton, Connecticut

Patient forms.
Ready for your visit.

Complete your forms online through Jane after your appointment is booked, or download one fillable PDF with everything you need for your first visit.

Your online patient portal

Watch for an email from Jane.

Once you are booked for your appointment, our office will create your online patient portal through Jane, the service we use for patient forms.

You will receive an email notification with instructions to access your portal. From there, you can complete your intake, consent and HIPAA forms online before your visit.

Be on the lookout for Jane.

Check your inbox and spam or junk folder after booking. If you do not receive your email or need help getting started, call our office at (203) 922-9277.

Prefer a downloadable PDF?

All your forms. One download.

Our four-page patient packet includes your new patient intake, treatment consent and HIPAA acknowledgement in one fillable PDF.

Type your answers and save the PDF, or print it and complete it by hand. Bring your completed packet to your appointment.

Download Patient Forms

For best results, download the file first and open it in a PDF reader that supports fillable forms. Save your answers before closing. Print on standard letter-size paper (8½ × 11 inches). You may sign by hand after printing.

Before you arrive

A little preparation.
A smoother visit.

Have your medication list and any relevant records available when completing your intake. Complete your forms through Jane before your appointment, or bring your completed PDF packet to your visit.

If you have questions about a consent or acknowledgement, leave that section for discussion with our staff before signing. Please do not send health forms through the general contact form.

Need help with your forms?

Call our office for help completing your forms or preparing for your first visit.

(203) 922-9277

2 Trap Falls Road, Suite 208
Shelton, CT 06484

Directions and contact information