Patient Forms

Are you ready to start Physical Therapy?! You can print these out and complete them before you come in for your first visit to save you time.

• Patient Information & Health History Form
• Patient Insurance Verification Form

You also might want to consider a good tool for you to understand your insurance:

• Patient Self Insurance Questionnaire Form – This form is a tool for you to use to call your insurance company to verify your physical therapy benefits.

Here are copies of our Policies. These are for your reference, you do not need to print these, save a tree!

• Notice of Privacy, Financial & Service Agreement Policies

Please choose ONE of the following four functional outcome measurement forms to complete before your first visit:

• Neck (this should be used if your problem relates to any of the following: neck pain, mid back pain, cervical spine problems, headaches, and thoracic spine problems, pain and/or numbness radiating into your shoulder/arm/or hand, and jaw/TMJ problems).
• Low Back (this should be used if your problem relates to the lower back).
• Upper Extremity (shoulder, elbow, wrist, etc.)
• Lower Extremity (hip, knee, ankle, etc.)
• Dizziness / Vertigo (identify difficulties due to dizziness or unsteadiness)

Fitness Program Clients click here.