FOCUS Therapy Fort Myers

Please carefully read & complete this online Patient Case History Form.

Note that submission of this form is only for patients who have already been in contact with our office staff at FOCUS. To send a general inquiry, please e-mail us at office@focusflorida.com or submit questions through our Contact Us page.

PATIENT CASE HISTORY

Please provide patient's case history and relevant information and electronic signature/initials where prompted.

Step 1 of 10

  • IDENTIFYING INFORMATION