Visit our Location
114 East Main Street
Fredericksburg, PA 17026
Give us a Call
(717) 820-4979
Send us a Message
ditzlerpt@ditzlerpt.com
Hours
Mon - Friday: See below

For your convenience, please find below our patient forms to print and complete prior to your initial evaluation. If you would prefer to complete the forms in our office, please plan to arrive 15-20 minutes before your scheduled appointment to allow enough time.

Patient Information Form
Download Form
Medical History (pt 1)
Download Form
Medical History (pt 2)
Download Form
Medication List
Download Form
Statement of Financial Responsibility
Download Form
Privacy Notice
Download Form
Appointment Cancellation Policy
Download Form
Platform Slot Gacor CMS Checker