Patient Info

New patients can save some time during their first visit by printing and completing the following forms:

Patient Forms:

• New Patient Form
• HIPAA Form
• Policies Form
• Appointment Reminder Form
• Medical Questionnnaire Form

Medicare Related Forms:

• Medicare Advanced Beneficiary Notice Form
• Medicare PT Fees

The following forms are for special circumstances:

• Motor Vehicle Lien Form
• Referral Waiver Form
• Release of Records Form
• Pool Release of Liability Form

For your information:

• Patient Bill of Rights

Questionnaires:

• Berg Balance Scale
• Disabilities of the Arm, Shoulder, and Hand (DASH)
• Lower Extremity Functional Scale (LEFS)
• Lysholm Knee Questionnaire
• Neck Disability Index (NDI)
• Optimal Instrument
• Oswestry Back Disability Index
• Upper Extremity Functional Scale (UEFS)
• Shoulder Pain and Disability Index (SPADI)
• Patient Specific Functional Scale