Patient Forms

Please print out and complete the patient intake forms based on your insurance information listed below. Bring in your completed forms on your first visit.

Additionally, please remember to bring these items with you for your initial visit:

  1. Insurance Card(s)
  2. Photo ID
  3. The physician referral for physical therapy
  4. Any recent reports from x-rays, MRI, surgical procedure, etc. (you can contact your doctor and ask to have these faxed to us at 526-2022)
  5. List of medications and/or supplements including dosages and route you take them (orally, patch, injection, etc.)

There may be additional paperwork you will be asked to fill out upon arrival for your first visit. Please plan on arriving 15 minutes prior to the appointment time you were given, which allow us time to complete your initial visit intake procedures, prior to you starting your physical therapy appointment.

If for any reason you need to cancel your first appointment, please kindly give us a 24 hour notice, so we may fill that time with another patient from our waiting list.

These documents are PDF (Portable Document Format) files and require Adobe Acrobat Reader. If you need to download the reader please visit this page.

PAPERWORK for patients with PRIVATE HEALTH INSURANCE, AUTO, WORKER'S COMP. & PRIVATE PAY:

PAPERWORK for MINORS (Under the age of 18 or whose parents are still financially responsible for medical care):