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KAREN BALZAC PHYSICAL THERAPY, PLC KAREN BALZAC, MPT 20614 HUTTON CIRCLE, LEESBURG, VA 20175 703.709.0074 CONSENT FOR EVALUATION AND TREATMENT OF PELVIC FLOOR DYSFUNCTION I acknowledge and understand

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What is pelvic floor treatment consent?

Pelvic floor treatment consent is a form that grants permission to undergo treatment related to the pelvic floor.

Who is required to file pelvic floor treatment consent?

Any individual undergoing pelvic floor treatment must file the consent form.

How to fill out pelvic floor treatment consent?

Pelvic floor treatment consent can be filled out by providing personal information, medical history, and signature.

What is the purpose of pelvic floor treatment consent?

The purpose of pelvic floor treatment consent is to ensure that the patient understands the treatment being performed and consents to it.

What information must be reported on pelvic floor treatment consent?

Pelvic floor treatment consent must include personal information, medical history, treatment details, and signature.

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