Thank you for taking the time before your first physical therapy
appointment to open, print and complete the new patient forms listed
below.
Click the links to download or open the pdf-files. You need
Adobe Acrobat Reader to
view them.
If your primary insurance is Medicare, please print and complete
ALL the forms listed on this page.
If
your primary insurance is not Medicare, please print and complete all the
forms EXCEPT the Medicare Requirements.
At your first appointment, please bring these completed forms,
your insurance card, and therapy prescription from your doctor.
Thank you and we look forward to meeting you!
1. Please fill out and sign the
Patient
Information Sheet.
2. Please tell us about you and your problem
on this
Questionnaire.
3. This notice describes how medical
information about you may be used and disclosed and how you can get access to this information:
HIPAA Notice.
4. And please carefully read and then sign
our
Cancellation Policy.
MEDICARE Patients only:
5. MEDICARE Patients please
additionally download, print, fill out and sign this form:
Medicare
Requirements for Physical Therapy Treatment
