Patient Forms

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 Orthotic Agreement

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 Upper Extremity Functional Scale (UEFS)Oswestry Back Disability Index

Shoulder Pain and Disability Index (SPADI)Patient Specific Functional Scale

READY TO GET BACK IN THE GAME?

Request an Appointment today by calling (800) 346-9153 or use our online form.

Request Appointment

Get Inspired

concussion

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October 15, 2021

Concussion Blog Part 3 – Headaches (HA) and Whiplash Associated Disorder (WAD)

Following a concussion it is not uncommon to experience a headache. Here are the various types of headaches…

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concussion comeback

Uncategorized

October 14, 2021

The Winding Road of Returning to Activity After A Concussion

By: Michael Geiger, PT, DPT, ITPT In our most recent blog post in our concussion series, we introduced…

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physical therapy head-injury

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September 19, 2021

What Does Physical Therapy Concussion Care Involve?

In unraveling the challenges of concussion management, practitioners start with understanding the patient's baseline. Baseline refers to pre-injury…

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