test New Patient Intake & Registration Portal Delaware NeuroRehab • Dover, Newark, & Lewes Physiatry Clinics 07. PATIENT CONSENTS & DISCLOSURES Notice of Privacy Practices: I acknowledge receipt of Privacy Practices and consent to health info processing. Practice Policies Agreement: I agree to practice terms regarding medical form fees and cancellation terms. AUTHORIZED PERSON 1 & RELATION AUTHORIZED PERSON 2 & RELATION DURABLE POWER OF ATTORNEY (DPOA)? No Yes LEGAL NAME OF DPOA ADDITIONAL CLINICAL NOTES OR REQUESTS Submit Patient Intake Registration