Intake Forms

Patient Intake Forms

Online Form

For your convenience, Therapydia offers two ways to complete your intake forms. To complete the online form, please select the clinic location below.

Therapydia DC
Select the following link to be be redirected to the online form.

Printable Form

If you prefer to print the forms, complete them by hand, and either email or bring them to the clinic, please download the PDF file.


Pelvic Health Intake Form

If you have schedule a Pelvic Health Evaluation, please complete the Pelvic Health Intake Form.

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Same & next day appointments available

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Therapydia DC

818 18th Street NW Suite 1000
Washington DC, 20006
Hello@TherapydiaDC.com
Phone: (202) 833-1381
Fax: (202) 833-1327

Our hours:
Mon: 8:30 am – 7:00 pm
Tue: 7:00 am – 5:30 pm
Wed: 8:30 am – 7:00 pm
Thu: 7:00 am – 5:30 pm
Fri: 7:00 am – 4:00 pm
Early or later times may be available upon request.

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