Patient Forms

Over time, we’ve developed practices and policies to help us provide maximum care for all of our patients. We’ve included our policies below for your convenience. If you have any questions concerning these forms, we will gladly assist you.

Please print and complete forms 1-3 and bring them to your first appointment.  Please include a list of all current medications with dosage and frequency.  Including prescription, over-the-counters, herbals and vitamin/mineral/dietary supplements.  It is important to come to your first appointment 15 minutes early for administrative purposes and so the therapist can do a thorough evaluation of your condition.

1) PATIENT REGISTRATION (print)

This registration provides our staff with all required information to contact, and assists us to facilitate your insurance claims.

2) MEDICAL HISTORY (print)

Your history informs the physical therapist of any physical conditions that may effect your treatment. It lets them know what you expect to gain from physical therapy treatment.

3) POLICY ACKNOWLEDGMENT / SIGNATURE PAGE (print)

By signing this document, you acknowledge that you have reviewed and approve of our policies.

4) FINANCIAL POLICY (read)

Our policy addresses most insurance scenarios, which you may find helpful. It is very important that you know the requirements and limitations of your individual policy.

5) CANCELLATION AND NO-SHOW (read)

Our Cancellation and No-Show Policies were developed out of respect of the physical therapist’s time and the time of other patients.

6) NOTICE OF PRIVACY (read)

These practices reflect national standards designed to protect your personal information. They define how we may use your medical records and our accessibility practices.

7) IMPORTANT QUESTIONS TO ASK YOUR INSURANCE COMPANY (read)

These are questions to help you determine your benefits for physical therapy.